Field of Science

Tonsillectomies and fat kids? Doubt it

I just stumbled across a news report on a study, published in the February issue of Otolaryngology, Head and Neck Surgery, that identified a correlation between having a tonsillectomy and weight gain in children. The authors performed a review of nine studies spanning the last four decades of tonsillectomies and report, according to MSNBC (the paper is not yet available on the journal Website), a "greater than expected" weight gain in children of normal weight and children who were overweight already following the surgery.

[IMAGE: Yes, children really do receive this "informative" T&A booklet, complete with suggestive imagery and terms, before having that T&A]

From MSNBC:
In one analysis of 127 children six months to one year after surgery, the average body mass index of the kids increased by about 7 percent. In another analysis of 249 children, 50 to 75 percent of kids had weight gain after surgery. While most weight gain happened in the first year after surgery, scientists don't know definitively whether it levels off after that.
Oh, dear. Alert the media...oh, never mind.

According to the report, the study authors speculate that the recent increase in childhood obesity might trace in part to the 500,000 children who undergo tonsillectomies every year in the United States. I'll get into the problem with that kind of speculation below. Let's just say that someone got to make a checkmark next to "Current buzzword used?" with that bit of imaginative thinking.

What the news report does not clear up is whether or not this "greater than expected" weight gain adds up to a gain into "overweight" or "obese" territory for children who were within normal weight parameters before the operation. As the piece notes, it's likely that children who have tonsillectomies for the usual indications--repeated strep infections, breathing difficulties--might start eating more or using the energy more efficiently post-op.

Furthermore, the report mentions that there are growth spurts and weight gain after tonsillectomy in the pediatric population. That is, in fact, the case: children who have tonsillectomy for sleep-disordered breathing show gains in height, weight, and growth after the surgery.

The piece closes with the standard de rigeur pap that parents should watch their offspring post-op for weight gain and talk to a pediatrician if they're concerned. The closure-satisfying implication is that the findings of this study are so, um, weighty, that they warrant a specific parental eye to those pediatric pounds after a tonsil surgery. Yes, just one more thing to add to the parental worry list, based on this report. Indeed, I'd be more inclined to caution parents to take their children to the pediatrician if the little wee one does not put on some weight post-op.

Here, I'll drag into this the fact that tonsillectomy rates have likely gone down since the 1950s, before the obesity epidemic struck. Indeed, until the 1960s, it was the most frequently performed surgical procedure in the United States. With the decreasing rates of this surgery over the decades, it's hard to come up with a way that it could be responsible for the increasing obesity rates during my lifetime, which began in the 1960s. (Weird coincidence note: The author of the paper I just linked happens also to have authored the introduction to a re-issue of Rats, Lice, and History, my current reading. These random event pairings are happening to me so much lately that I'm starting to get suspicious).

The head and dek of this MSNBC piece are as follows:

Getting tonsils out tied to kids' weight gain

Researchers wonder if common surgery plays role in child obesity epidemic


Oversimplifying headline aside, the dek in particular makes no sense in the harsh light of common sense and facts. What's to wonder about? A child--like mine--has repeated strep infections, which in children can mean fevers, low dietary intake, and vomiting for days, a cycle that repeats the minute every antibiotic treatment ends. Guess what? Post-surgery, that child's going to put on a few pounds once they can (a) swallow again without pain, (b) do so without vomiting, and (c) live for weeks at a time without contributing valuable energy to a fever rather than to growth.

I'd have been surprised if the researchers had not found weight gain following tonsillectomy. It's the obvious hypothesis, unlike the silly speculation that this operation might be contributing to the "obesity epidemic." That's just dropping in a buzz phrase in a desperate grab for clicks and eyeballs, and nothing more. In this case, it looks like the researcher carries some of the load for overreaching. Anyone want to hypothesize whether or not there are gains involved in that?

ETA: Now there is a growing list of links for this story, so I've annotated below. Many include more commentary on "childhood obesity" in the context of these findings (which don't seem to have much to do with obesity), while others gloss over the findings and launch straight into a lot of statistics about childhood obesity.


THREE-WAY TIE FOR MOST MISLEADING HEADLINES
Leave it to a blogger to get a good headline out of this story and to make a decent point: Tonsil removal possibly linked to weight gain in children. Blogger notes "scratching her head over this one," as either the child needs a tonsillectomy or the child does not; what does this information do for us?

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Study citation
Otolaryngology — Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology — Head and Neck Surgery Foundation (AAO-HNSF). The study’s authors are Anita Jeyakumar, MD; Nicholas Fettman, MD; Eric S Armbrecht, PhD; Ron Mitchell, MD.

10 comments:

  1. So weird, I saw an article about tonsillectomy being associated with weight gain the other day... but in the context of underweight kids who have sleep apnea (and thus burn more too many calories while sleeping)...

    http://www.parentcentral.ca/parent/familyhealth/children%27shealth/article/927417--the-tonsil-transformation

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  2. The just-released practice guidelines(linked above in the text) discuss the same thing. The only concern expressed is about the weight loss in those kids before the surgery and weight loss just after surgery b/c of an inability to eat or keep down food. The aftermath of tonsillectomy is not pleasant and lasts 2 weeks.

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  3. Nice highlighting of poor headlines. Its a dirty job but someone has to do it.

    I did have one question regarding your tonsillectomy rates. Im not sure if you are saying the # of tonsillectomy surgeries going down / population size or that the rate of tonsillectomy surgeries compared to all surgeries is going down.

    If the latter, the rate could decrease by decreasing the numerator or increasing the denominator. I ask because the # of surgical approaches available have increased dramatically over the last 4-5 decades.

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  4. Hi, Lorax. Thanks for posting. It's # per population size. Before the 1970s, maybe 1960s, just about everyone had their tonsils removed. It was just something people had done...they thought that tonsils were something you didn't want to keep around. The doctor quoted at the end of this piece puts it best: "Wei points out that virtually an entire generation of children born prior to World War II had their tonsils removed to prevent rheumatic fever, which often proved fatal before the era of antibiotics.

    'That generation certainly did not become obese,' she says." The practice was still common after WWII, as both of my baby boomer parents and all of their peers had tonsils removed as a matter of course. So, if rates in the population have gone down from near saturation to what they are today--which is not near saturation--I can't see how there can even be a correlation suggested. In fact, were this really the question, "Is there an association between childhood obesity rates and tonsillectomy rates in the pediatric population?", then the better examination would have been to look at correlation of those rates.

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  5. My child was underweight before he had his tonsils removed. He went from 32 to 40 pounds in several months, a 25% weight gain. That would have been fine, but it didn't stop there. We have been fighting his weight ever since. Lest you think we are junk food junkies, please know that my 5'10" husband weighs 136 pounds, I'm 5'8" at 132 (was 110 in high school, even at that same height - am now in my 40s), and my daughter is in 50 percentile height & weight. We consume NO HFCS, NO hydrogenated fats, and very few processed foods (organic cereal the exception), eat lots of organically grown local fruits & veggies, pastured organic meat & milk. We eat tiny portions. My son exercises daily (swimming, tennis, baseball, fencing, riding, biking), yet is still off the charts. It is NOT a laughing matter. There IS a link, and I can confidently argue that diet and exercise are NOT playing a role with my son, and there was an obvious change in his metabolism after the surgery. It is as if a switch has not been turned off in his weight gain. Just as not all people have reactions to drugs, not all people are going to have reactions to tonsillectomy/adenoidectomy, and there HAVE always been chubby kids - even in the 40s and 50s. There just didn't happen to be studies back then about any links.

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    Replies
    1. I was a thin child, I was even only 5 pounds when I was born. I had my tonsils and adenoids removed when I was seven, I gained so much weight directly after and after years of struggling with weight at 25 I am still obese.. My father, my mother nor my full blood brother had any problems with weight as a child... my mom only gained weight after having my brother and I. So my point is I don't have genes to all of a sudden blow up like a balloon. I am so heartbroken now that I been researching and have come to realize that my childhood surgery caused my weight gain. I have tried so hard to loose weight countless times, It hasn't worked thus far. So there is a link between the surgery and weight gain I unfortunately am proof.

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  6. A few points:

    1. The plural of anecdotes /= data, and a single anecdote is just a single anecdote. I can cleanly counter your anecdote with my own: My son had T&A and hasn't gained anything. (-) anecdote + (+) anecdote = zero. If your son is experiencing what you describe, take him to an endocrinologist.

    2. They can't say that the childhood obesity trend is "new" unless they knew what obesity trends were like before that line began to trend upward. Ergo, someone has those data for comparison. "They" did track these things before television existed.

    3. There has been no mention of causation here, so metabolic effects have not been brought up. This was a review of a handful of previous studies covering four decades and not that many children. There is no indication of causation of any kind. Just a notation of some children's having gained weight after the surgery.Indeed, it remains unclear whether the weight gain extended beyond the 1st year following surgery, as there are no longitudinal data, and it also is unclear whether or not the weight gain in general took children outside of what would be considered a healthy BMI. And I won't even get started on the issues of even using BMI as a parameter.

    4. This is still not a study about causation, and it certainly does not link anything to the current childhood obesity epidemic; that is pure speculation. See above.

    5. My issue with this study is not that it found that children gain weight after tonsillectomy. As I noted, that's kind of a "duh" finding. My issue is the tracing of this finding as being causative in the current childhood obesity epidemic, which emerged not only in the headlines but also in the author quotes in the stories. Given that there is zero evidence, correlative or causative, to support this speculation, it strikes me as irresponsible at best and a cynical buzzword manipulation at worst.

    6. Nowhere do I say that I find this a laughing matter. In fact, I am quite serious. Irresponsible headlines leave behind unnecessary negative effects that include enhancement of parental anxiety about a necessary operation. It's generating groundless worry manufactured in headlines, and that's counter to supporting public health. What is a parent supposed to do about it anyway? Opt out of the operation because of a concern about weight gain and continue to let their child suffer repeated strep throat infections + vomiting + antibiotics? I submit that the selection for resistant bacteria that the antibiotics use exerts is a far greater danger than whatever weight gain may occur in a small population of children undergoing the surgery.

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  7. Regarding weight gain and tonsillectomy. My sister, brother and myself (female) all had our tonsils removed in the late 1940's. Before the operation, we were all thin, actually skinny. Within a few years, both my sister and myself became very overweight and it wasn't because of overeating. My brother remained thin. Back in those days, there was no junk food, no snacking and all meals were healthy-made from scratch. I've often wondered if there was a connection because I could never understand why we gained weight.

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  8. I'm overweight and I had my tonsil and adenoid removed, and I know a couple of people who also did that procedure and also gained weight afterwards. I was really skinny as a kid, but a couple of months/years after the procedure, I started gaining weight like nuts, I was really really fat, and even now, to try to avoid a big belly, I have to endure a really strict diet and lots of exercise. I'm no doctor, but seeing so many people saying the same thing, is really strange if there's no correlation whatsoever, specially with links like this one http://www.steadyhealth.com/weight_gain_after_tonsillectomy_t78871.html where everyone says the same..

    I really noticed an increase of my hunger, honestly I believe that I started to eat more and to get hungrier after the procedure, but dont really know why. And if it's hormonal, I'd love to know what I can do to help my body be like it used to.

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  9. I had my tonsils and adenoids removed when I was nine. I'm still under normal BMI and eat/excercise the regular amount. I think any link may be genetic, as my relative lack of changes was the same for my mother, grandmother, and sister.

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