About 4.5 million American children are severely obese, and pediatricians say more of them should be recommended to get weight-loss surgery.

A new policy statement from the American Academy of Pediatrics (AAP) asserts that the obesity epidemic now places many children and adolescents at risk of living significantly shorter lives than their parents. While pediatricians can help patients lose weight through lifestyle changes, these adjustments often don't result in significant or lasting improvements in children with severe obesity, who may be more than a hundred pounds overweight, according to the paper, published Oct. 27 in the journal Pediatrics.

"While lifestyle changes remain the mainstay of treatment, medical care is unlikely to significantly change the trajectory for most children with severe obesity," Dr. Sarah Armstrong, a Duke University professor of pediatric medicine and lead author of the policy, said in a statement. Over the last decade, studies have shown that weight-loss surgery is safe and effective for children and teens when performed in high-quality centers, Armstrong said. But the procedure is currently underutilized among children who could benefit from it, she added.

In children, severe obesity is defined as having a body mass index (BMI) of at least 120% of the 95th percentile for one's age and sex, according to the statement. At this weight, children and teens face greater risk of developing chronic diseases than their peers. Health conditions such as high blood pressure, sleep apnea and type 2 diabetes occur more often in severely obese children, along with mental health conditions such as depression.  

Weight-loss surgery may offer a better solution than standard treatment for severe childhood obesity and its accompanying health problems, wrote Armstrong and her co-authors. The group compiled studies of people 18 years old and younger who had undergone the procedure and found that many enjoyed lasting weight loss and a reduction in related health conditions. For example, one study followed adolescents up to 12 years post-surgery and found that patient BMI dropped 29%, on average, and the incidence of diabetes and high blood pressure dropped significantly. In contrast, severely obese children who made only lifestyle changes gained weight in the long term.

In addition, few patients who had the surgery experienced complications, and when they did, the problems were usually minor, the report said. But despite its safety and effectiveness, weight-loss surgery isn't a "quick fix," Armstrong told the Associated Press. "It's a lifelong decision with implications every single day for the rest of your life," she said. After surgery, patients must stick to "specific nutrition and activity recommendations," according to HealthyChildren.org, the AAP informational website for parents.

Unfortunately, as of now, most kids with severe obesity don't get weight-loss surgery because it's usually not covered by public or private health insurance, and it can cost up to $20,000, Armstrong told the AP. Some children may live far from surgery centers, which also reduces access to the surgery, she said. In its policy statement, the AAP said that insurance should cover both the surgery and follow-up care in order to enable more children with severe obesity to undergo the procedure. 

Although pediatric obesity surgery rates have tripled in recent decades, American doctors still perform fewer than 2,000 operations each year, the AP reported. Faith Newsome, now a senior at the University of North Carolina in Chapel Hill, underwent the procedure at age 16. At the time, she was 5 feet, 8 inches tall and weighed 273 pounds, meaning her BMI was almost 42. The following year, she dropped about 100 pounds. Today, her weight is within a normal range.

The AP asked if she ever regrets the surgery.

"Never," Newsome said. "Teens should be able to discuss every option with their doctors, and surgery should be one of those options."