Studies have indicated that adenotonsillectomy may be associated with significant weight gain after surgery, a problem that can be concerning for both parents and patients. Previous research also suggests that the postoperative weight gain associated with adenotonsillectomy occurs mostly in children who undergo the procedure as treatment for diagnosed obstructive sleep apnea (OSA).

“Potentially worrisome weight gains following adenotonsillectomy occurred primarily in children under the age of 6 years who were underweight or normal weight to begin with.”

At the 2012 annual meeting of the American Academy of Otolaryngology–Head and Neck Surgeons, my colleagues and I presented data from a study involving a large population of children undergoing adenotonsillectomy and the demographic factors that may contribute to weight gain. We analyzed medical records of children aged 6 months to 18 years who had their tonsils removed between 2008 and 2011. These data were then refined to only include medical records for children who were routinely examined for at least 6 months after their surgery and had recorded height and weight measurements. All patients in the study had a history of OSA or recurrent tonsillitis.

Who’s At Risk for Weight Gain?

Results of our analysis showed that, on average, patients had a weight gain of 0.5 to 2.0 lbs— equivalent to a 0.4- to 0.6-point increase in BMI scores—after their surgery. Importantly, the gains that were observed were not dependent on whether the children had OSA or recurrent tonsillitis. In a multiple linear regression analysis that controlled for gender and height, only age was significantly and negatively associated with changes in BMI. Potentially worrisome weight gains following adenotonsillectomy occurred primarily in children younger than 6 who were underweight or normal weight to begin with.

Putting Findings Into Perspective

While the weight gain after pediatric adenotonsillectomy that was seen in our study might appear to be small, it’s important to recognize that even minor weight increases can be quite worrisome, especially to parents. That said, our findings should help alleviate rising concerns from parents that adenotonsillectomy may aggravate health problems in children who are already overweight. For parents of adolescents requiring the surgery who are normal weight, there should be less concern for new-onset obesity to develop after the procedure. Parents with younger children and those with overweight kids should be instructed by their physicians to closely observe their child’s diet after surgery and make caloric adjustments when necessary.

More research is needed because the underlying causes of weight-gain after adenotonsillectomy are still unknown for these patients. Further investigating the relationship between weight gain and demographic factors and paying special attention to the impact of age with prospective evaluations would be of benefit. My colleagues and I plan to prospectively monitor children immediately after surgery to determine which factors or interventions result in weight gain after adenotonsillectomy. We’re also taking measures to ensure that those who are overweight do not gain weight after their procedure.

References

Levi J, Leoniak S, Schmidt R. Evaluating tonsillectomy as a risk factor for childhood obesity. Arch Otolaryngol Head Neck Surg. 2012;138:897-901.

Wei JL. Weight gain after tonsillectomy: myth or reality? Interpreting research responsibly. Otolaryngol Head Neck Surg. 2011;144:855-857.

Wijga AH, Scholtens S, Wieringa MH, et al. Adenotonsillectomy and the development of overweight. Pediatrics. 2009;123:1095-1101.

Fernandes AA, Alcântara TA, D’Avila DV, D’Avila JS. Study of weight and height development in children after adenotonsillectomy. Braz J Otorhinolaryngol. 2008;74:391-394.

Roemmich JN, Barkley JE, D’Andrea L, et al. Increases in overweight after adenotonsillectomy in overweight children with obstructive sleep-disordered breathing are associated with decreases in motor activity and hyperactivity. Pediatrics. 2006;117:e200-e208.