TUESDAY, Feb. 1 (HealthDay News) -- Weight gain is common after
children have their tonsils removed, an analysis of four decades of
Researchers from Saint Louis University found that 50 percent of
the children in the studies gained more weight than expected as
part of normal development, according to study lead author Dr.
Anita Jeyakumar. While not "hugely surprising," the findings are
important to consider in light of the obesity epidemic and the
frequency of tonsillectomy, she said.
"About 30 to 50 percent of this generation of children is overweight so anything that can exacerbate that should be looked at very closely," said Jeyakumar, a pediatric otolaryngologist at Saint Louis University Medical School.
Although fewer tonsillectomies are performed today than 40 years
ago, it is still one of the most common major surgical operations
performed on U.S. children, she pointed out. Doctors and parents
should take the study findings into account when deciding if a
child needs the procedure, said Jeyakumar, also an assistant
professor of pediatrics.
The analysis, published in the February issue of
Otolaryngology -- Head and Neck Surgery, included nine studies on tonsillectomy alone or tonsillectomy with adenoidectomy (removal of the adenoids) published between 1970 and 2009. The 795 children involved were 18 years of age or younger and ranged from normal weight to morbidly obese. The research was divided into three sections based on how weight was measured, and the participants were followed for an average of one year.
The first group, with 127 patients, measured body mass index
(BMI). On average, the BMI of children in that group increased
about 7 percent after surgery and was 3.6 percent greater than a
The second group, with 419 children, used standard U.S. height
and weight charts. Weight gains were noted in 46 percent to 100
percent of this group, the researchers found.
Various methods were used to assess weight in the third group,
involving 249 patients. From 50 percent to 75 percent of those
children gained more weight than expected based on growth and
development, according to the analysis.
A small number of children in the studies lost weight after the
surgery, the study found.
The small number of studies included in the research reflects
inconsistencies in the recording of medical information, which
makes comparisons difficult, the authors noted.
The tonsillectomies were performed on children who had repeated
infections, or sleep-disordered breathing, which disturbs sleep and
disrupts breathing briefly but repeatedly. The condition is
sometimes linked to frequent infections of the upper respiratory
Jeyakumar cautioned that the study did not show why the children
gained weight or even prove that the reason they did was because
they had tonsillectomies.
Theories about post-tonsillectomy weight gain suggest that
children who were hyperactive prior to surgery became calmer and
more focused afterward, thus using fewer calories, according to
research cited in the study. Children with disturbed sleep probably
burned more calories as they struggled to breathe, other research
suggested. Both conditions are common in children with chronic
Another theory cited is that parents may tend to "over-feed"
children recovering from surgery.
"The main thing is that no one should panic," Jeyakumar said. "Every patient needs to be evaluated individually, and parents need to be aware. It doesn't mean the child shouldn't have the surgery" if weight is a problem.
Another expert agreed, saying that the study wouldn't change his
practice. "If I send a child for surgery, he needs surgery," said
Dr. Dennis Woo.
"When these kids gain weight after surgery it can be for a number of reasons. We can be hard-pressed to sort through it and say 'it's mostly this, or mostly because of that,'" said Woo, an associate professor of pediatrics at the University of California Los Angeles David Geffen School of Medicine.
But this study "would be another reason to be sure that surgery
is necessary for a child," he said.
For children with breathing-related problems, the authors
suggest trying continuous positive airway pressure (CPAP) before
resorting to surgery. Also, doctors should make dietary and
lifestyle recommendations for young tonsillectomy patients, they
Another recent report, published in January 2011 by the American
Academy of Otolaryngology--Head and Neck Surgery, provided new
guidelines for doctors determining the need for tonsillectomies.
The guidelines advise antibiotics and a "wait-and-see" approach for
moderate cases, noting that these cases usually resolve over
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