Anesthesia and Weight Gain in Children

[Mykeru]

In a discussion with a co-worker on the "link" between autism and vaccination, which I explained to be a correlation without causation (i.e., autism manifests itself at the same developmental stage that children tend to be vaccinated, which isn't the same as a causal relationship), she stated that she has noted another, and apparently original, "causal" connection between the use of anesthesia on young children under ten years old and long-term weight gain.

It apparently works like this: She claims that her daughter didn't have a weight problem until she was anesthetized to have her tonsils and adenoids removed. After that her daughter developed a chronic problem with being overweight, not just a temporary gain during recuperation. She claims the same connection exists according other parents she has spoken to.

Way ahead of you: I hypothesized that 1. The weight problem might have manifested itself anyway. 2. Although chronic it may have had its inception in illness, convalescence and perhaps some doting on the part of the parents.

Of course, the claim fits neatly into the whole rubric of confirmation bias, the fallacy of selection and, in general, correlation without causation. I did explain that it was exactly the sort of phenomena where parents suspecting anesthesia caused their child's weight problem would tend to count the hits when talking to other parents and ignore the misses, that is, children that didn't manifest weight problems, such as my own sister, who had her tonsils out about the same age.

I should note that I don't support the historical tendency to rip out a kid's tonsils at the drop of the hat. Whether this is overdone is another issue. The issue is not that procedure, or any other, but the long-term effects claimed to be caused by anesthesia.

Question is, after Goggling the claim, and searching for either woo or debunking on the issue, I couldn't find anything. My co-worker did say that she noticed her connection herself, so we might be witnessing the invention of another "vaccination causes autism" type parental panic, even if there is nothing behind the claim. Then again, maybe she has something there. I doubt it, but evidence might support the phenomena even though I can't imagine what sort of mechanism might be behind it, which would make dismissal out of hand pure argument from ignorance.

Who knows where this could lead: Beneficially, perhaps it would cause parents to wait on having questionable procedures performed on children. Conversely, it could cause parents to withhold treatments that are very necessary (like vaccination). And perhaps transport children back to the wonderful 19th century world of surgery performed with nothing more than some Red-Eye and a bullet to bite on.

So, has anyone else come across this causal claim, that anesthesia used on children at a young age can cause long-term weight gain, whether it be woo, skepticism or, at best, controlled studies?

[Tortan]

Perhaps she should keep a close reign on what her child eats rather than jumping to conclusions. There's also the matter of the whole "Yay, I get to eat ice cream after getting my tonsils removed" factor. Maybe it started a bad pattern in her. It's always possible that the kid is simply sneaking food without her parents noticing. I know I did it when I was a kid.

I've never heard of this claim previously, so it sounds new to me.

[Modified]

... she stated that she has noted another, and apparently original, "causal" connection between the use of anesthesia on young children under ten years old and long-term weight gain.

It apparently works like this: She claims that her daughter didn't have a weight problem until she was anesthetized to have her tonsils and adenoids removed. After that her daughter developed a chronic problem with being overweight, not just a temporary gain during recuperation.

If there was anything to it, I would suspect the not eating for a day to be the cause, and not the anesthesia.

[Mykeru]

Perhaps she should keep a close reign on what her child eats rather than jumping to conclusions.


Well, yes, parenting style is one variable that would have to be eliminated from the possible causal variables.


There's also the matter of the whole "Yay, I get to eat ice cream after getting my tonsils removed" factor. Maybe it started a bad pattern in her.


Perhaps I didn't qualify this enough. Tonsillectomy is one procedure cited because, obviously, it's one of the most common procedures performed on children of this age. However, if one is to believe the claimants, the phenomena occurs with other procedures. So I don't want to get hung up with the obvious cause of post-surgical ice-cream eating after a kid's tonsils are removed.

At the same time, I would want to dig deeper to figure out why the parents claim it's the anesthesia that is causal. Why isn't it say, repressed memories of green surgical scrubs, exposure to Jell-O (far more likely than ice cream), or Hello Kitty pillow cases. Part of my interest in something like this, which I suspect to be pure woo, is why parents choose a particular mechanism (vaccines, anesthesia) over another. All part of why people believe certain causal connections.

It's always possible that the kid is simply sneaking food without her parents noticing. I know I did it when I was a kid.


Well, yeah: The obvious mechanism of long-term weight gain is consistent over-eating.

I've never heard of this claim previously, so it sounds new to me.


Me too, which is why it's interesting: Getting in on a claim of this type on the ground floor.



If there was anything to it, I would suspect the not eating for a day to be the cause, and not the anesthesia.




Huh? I don't quite follow how not eating for a day relates to long-term weight gain.

[petra10]

My son has had many trips to the theatre.From birth till he was 10 I think he was anesthesised (spelling?) at least 12 times. He is 17 now and never had any wieght problems.Lots of children in his ward have also been anesthesised (?) many times and I have never heard of any having weight problems.

Sometimes parents like to blame anything on their childrens weight problems than take responsiblity themselves.

[Modified]

Huh? I don't quite follow how not eating for a day relates to long-term weight gain.

After not eating for a day, I will be extremely hungry for the next week or so. Eating a lot can easily become a habit.

[fls]

I suspect that the event merely serves as a convenient memory tag and the anaesthesia is a fairly obvious scapegoat (it is a fairly unique event, as opposed to visiting a doctor or exposure to green jello). It is very difficult to time an event, especially something that happens gradually, such as weight gain. In order to narrow it down, you start to think about definite events (like when the kid started school or when they had an operation) and ask whether or not it was present beforehand. It's a small step from "before the operation, my kid was not overweight, so it started sometime afterward" to "my kid started to become overweight at the time of the operation". The same thing happens with autism and vaccines, and even as part of the placebo effect.

Linda

[Mykeru]

My son has had many trips to the theatre.From birth till he was 10 I think he was anesthesised (spelling?) at least 12 times. He is 17 now and never had any wieght problems.Lots of children in his ward have also been anesthesised (?) many times and I have never heard of any having weight problems.

True. One of the first things I thought of is the incidence of counter-examples. My sister being one. Problem is, like the vaccination crowd, I suspect counter examples won't make a dent in confirmation bias.



Sometimes parents like to blame anything on their childrens weight problems than take responsiblity themselves.

Well, criticizing parenting is where I think the waters get muddied and can explain why parents might become recalcitrant in the face of falsification of their claim. There's so many issues where the almost automatic response is "well, if you weren't such crappy parents..." that the issue gets almost politicized. Some parents have kids that gain weight, do drugs, get pregnant, commit mass murder in school shootings and don't floss regularly. After the fact it's sometimes difficult to lay the blame entirely on the parents.

If children were so easily programmed, there would be a manual.

[Mykeru]

I suspect that the event merely serves as a convenient memory tag and the anaesthesia is a fairly obvious scapegoat (it is a fairly unique event, as opposed to visiting a doctor or exposure to green jello). It is very difficult to time an event, especially something that happens gradually, such as weight gain. In order to narrow it down, you start to think about definite events (like when the kid started school or when they had an operation) and ask whether or not it was present beforehand. It's a small step from "before the operation, my kid was not overweight, so it started sometime afterward" to "my kid started to become overweight at the time of the operation". The same thing happens with autism and vaccines, and even as part of the placebo effect.

Linda

Linda,

That sounds eminently reasonable and is pretty much in line with what I think. Hume would describe this as ascribing causation by "juxtaposition of events". Or, if you like the Latin, "post hoc ergo propter hoc" thinking: That because one event followed the other, the prior event caused the latter. Obviously the ascribed causal event would have to be somewhat unique, because you can't say "before this happened" if the thing blamed is so banal as to have invariably been present before.

It's a perfect analog to the sort of thinking of the "vaccines cause autism" parents which, of course, is just the latest variation of "that powerline caused my kid's leukemia" claims. Like the "vaccinations gave my kids autism" claims, the surgical procedure happens to coincide with a developmental phase where kids prone to obesity either by genetics, changes in activity level, or being fed enormous quantities of Mac 'n' Cheese might start manifesting weight problems.

As Kurt Vonnegut would say, "And so it goes".

I'm interested, as my coworker says she has discussed this supposed phenomena" with other parents, if this particular canard can get the sort of traction other "X did Y to my kid" correlations without causation have in the past.

[fls]

Linda,

That sounds eminently reasonable and is pretty much in line with what I think. Hume would describe this as ascribing causation by "juxtaposition of events". Or, if you like the Latin, "post hoc ergo propter hoc" thinking: That because one event followed the other, the prior event caused the latter. Obviously the ascribed causal event would have to be somewhat unique, because you can't say "before this happened" if the thing blamed is so banal as to have invariably been present before.

I think this is a bit different from post hoc ergo propter hoc, although I think the two blend into each other. In one case, the events are juxtaposed - one thing happens and then one notices another thing happening. In the other case, well after both events have occurred, one looks back and recalls the events as juxtaposed. Prospective vs. retrospective. I only make the distinction because it broadens the sort of biases one takes into consideration, and can maybe change the way those biases are addressed (demonstrating that the association is due to confounding vs. accurate timing of the events shows that they were not associated in time).

Linda

[Mykeru]

I think this is a bit different from post hoc ergo propter hoc, although I think the two blend into each other. In one case, the events are juxtaposed - one thing happens and then one notices another thing happening. In the other case, well after both events have occurred, one looks back and recalls the events as juxtaposed. Prospective vs. retrospective. I only make the distinction because it broadens the sort of biases one takes into consideration, and can maybe change the way those biases are addressed (demonstrating that the association is due to confounding vs. accurate timing of the events shows that they were not associated in time).

Linda

I get the distinction. I think: Rather than looking for causal juxtaposition at the time of the events (like billard balls in action), one must wait until the supposed "effect" such as autism or weight gain occurs and then dig about in recollection (subject to being fragmentary and often confabulated) for the supposed causative agent. Looking for an immediate post hoc cause is different than what happening here, which amounts to looking back for the biggest Red Herring in memory.

Similar logic to the other cases of the Fallacy of Selection (which overlaps with confirmation bias, post hoc in a way that demonstrates that these sort of claims are constructed on a matrix of related fallacies of causation) where a child develops leukemia and the parent looks about for...Oh! It's the Power line (ignore the statistical clumping that invariably also figures into power line leukemia claims). Or a child develops autism and what happened at that time...Oh! The vaccination! (Rather than, say, the birthday party where they were all creeped out by Winkie the Clown). In this case the child develps a weight problem and what was different...well, pick something.

It's the sort of thing that could easily be sorted out with a proper sample to establish whether there is any correlation between anesthesia and childhood obesity before one even bothers to delve into possible causation. I rather doubt there's even correlation, which is why I initially asked if anyone has seen enough of this woo kicked around for someone to bother to do a study.

That's to say: Before one bothers explaining a phenomena, it helps if one establishes if there's a phenomena to be explained. I doubt that's even the case that there is a phenomena to be explained except for the most sparse sort of anecdotal claims which, incidentally, never stops litigation for a second.

[Soapy Sam]

Anaesthesia was the Tsar's daughter, wasn't she?
The ole Bolsheviks had a weight loss regime for the whole squad.

Excessive hair washing causes teenage girls to grow breasts you know.
Boys don't grow them and they wash their hair about 1/8th as often as girls.

QED.

[kerikiwi]

I think he was knocked out at least 12 times. He is 17 now and never had any wieght problems.Lots of children in his ward have also been knocked out many times

Is that better? ;)

[whatthebutlersaw]

You know, I noticed a similar thing with both me and my brother. We both were underweight until we had our tonsils out and then gained rapidly until we were overweight and even obese. I always wrote it down to finally being able to eat. Chronic tonsillitis _hurts_... you don't even want sweets. (and your breath smells like a$$)

There is no way I will believe anaesthesia did that. I did notice, while losing the weight, that I need a lot less calories in a day than the recommended 2000kcal if I want to not gain weight, so being able to eat "normal" amounts obviously made me gain weight because my body utalised less than the recommended daily average intake. So while eating as recommended, I still gained weight because the recommendations did not fit my life style and genetics.

If you believe that the guidelines don't have occasional exceptions and eat like you're told and still gain weight - of course you wonder how come. Anaesthesia did not fuxx with my metabolism - I was born to eat less and as long as eating hurt, I _did_ eat less and when it didn't hurt anymore, I ate more. I never wondered why I gained weight, because I knew I ate more than I used to.

Luckily, I was grown up at the time and could make my own dietary decisions.

It's harder with kids, because their well being is often filtered throught a parent who has love, pride and fear of being A Bad Parent invested in them.

[SteveGrenard]

You know, I noticed a similar thing with both me and my brother. We both were underweight until we had our tonsils out and then gained rapidly until we were overweight and even obese. I always wrote it down to finally being able to eat. Chronic tonsillitis _hurts_... you don't even want sweets. (and your breath smells like a$$)

You hit the nail on the head. Kids with large tonsils and adenoids are lousy eaters.
Unfortunately they are also lousy breathers and ergo lousy sleepers so T&As are
of definite benefit. But by removing the impediment to overeating these kids do gain weight. It has nothing to do with the anesthesia. It is the result of what I call rebound eating after years of difficulty swallowing their food. Some kids start eating so much I have met parents who ask if their kid's tonsils can be put back in! Parents need to control their kids eating habits; to do otherwise is a form of child abuse when their ten year olds weigh more than adults.

They should also be counseled that the surgery can result in this problem and why.

We test children down to age 2 in the sleep lab before recommending tonsillectomy and adenoidectomy.

[Mykeru]

It has nothing to do with the anesthesia. It is the result of what I call rebound eating after years of difficulty swallowing their food. Some kids start eating so much I have met parents who ask if their kid's tonsils can be put back in! Parents need to control their kids eating habits; to do otherwise is a form of child abuse when their ten year olds weigh more than adults.

I'm open to suggestion on how to express this idea -- controlling the kid's eating habits -- to a parent without having my rearward-facing orifice handed to me.

Let alone accusing the parent of abuse. That's the only non-constructive point you make in an otherwise very sensible post. Not everything is abuse and I tend to think people kick the word around far too easily, so much so that actions by parents that once would have been thought perfect for teaching a kid a lesson can get a parent charged with a felony. I can't post links yet, so just Google "Journalist Arrested for Telling Son to Walk Home from McDonalds".


The idea of "rebound eating" is interesting. Others have expressed it and makes the "causative" agent in the post-op weight gain not the anesthesia, but an after-effect of recovering from the tonsils and adenoid condition itself. Makes sense, although I'm not surprised it is claimed for other procedures by parents simply to buttress the initial "it was the anesthesia" claim.


They should also be counseled that the surgery can result in this problem and why.


So true: My father just had cryo-surgery to remove some cancerous growths from his prostate. The doctor actually doing the surgery told him exactly jack about post-op complications and the potential Hell-on-Earth that would be eating anything that would make one constipated after surgery (think soft, tenderized prostate and what straining to have a bowel movement might entail and you too can break out in a sympathetic cold sweat). Luckily, he got this information from his regular physician. Some doctors are simply not particularly good communicators and people persons. You'd almost think that kind of doctor is in it for the money rather than the altruism, as difficult as that might be to imagine.

I had previous written, "It's the sort of thing that could easily be sorted out with a proper sample to establish whether there is any correlation between anesthesia and childhood obesity before one even bothers to delve into possible causation. I rather doubt there's even correlation..."

I can't really see correlation with anesthesia, but can definitely see how it would be possible for there to be correlation with "rebound eating" after any sort of recovery, especially from a condition that prevents one from eating. Not just tonsils. I can see the same happening, say, after someone who is put on medication to treat Gastro-Intestinal Reflux and a whole slew of conditions which would make eating and unpleasant, if not painful, condition. I myself have GERD and I can tell you that I like eating, but hate having eaten, if you know what I mean.

[SteveGrenard]

I'm open to suggestion on how to express this idea -- controlling the kid's eating habits -- to a parent without having my rearward-facing orifice handed to me.

Let alone accusing the parent of abuse. That's the only non-constructive point you make in an otherwise very sensible post.

I qualified my "abuse" remark by saying "a form of child abuse." The observation was for third parties looking at the problem. I did not suggest anyone should actually up front make such an accusation to the parent(s) of a ten year old who weighs 220 pounds.

I agree this is a delicate subject and needs to be broached very carefully with parents who think that overstuffing their kids is a good thing when it is, in fact, the polar opposite: a bad thing. I don't know how much time a lot of doctors and counselors have in dealing with this subject but I feel that if you can explain to parents why it is so unhealthy for them to encourage or allow their kids to overeat you can make the case. If parents who love and care about their kids, and I am sure they're few that don't, can be made to understand they are "killing them with kindess" and are condeming them to early onset of diabetes, hypertension, cardiovascular disease and obstructive sleep apnea .....then you're doing a good thing.

[petra10]

Its not a matter of criticizing parents or calling them "crappy parents".
Its a matter of educating people about food and finding a health balanced diet.Due to my son's illness he developed diabetes.We were taught by doctors and dietians all about fat, sugars and carbs.Wow was I suprised by all the stuff I didnt know about.The most important thing is to read labels and understand excatly what is in the food you buy.

[Mykeru]

I qualified my "abuse" remark by saying "a form of child abuse." The observation was for third parties looking at the problem. I did not suggest anyone should actually up front make such an accusation to the parent(s) of a ten year old who weighs 220 pounds.


I'm sorry if I sounded a bit adamant, which is a result of my telescoped style of forum writing. I understand perfectly that you didn't mean it was child abuse per se. Then again, after being around Child Protective Service folks years ago, because my then girlfriend worked for CPS, you'd be amazed what some people consider abuse, some of whom have the power of the state behind them.


I agree this is a delicate subject and needs to be broached very carefully with parents who think that overstuffing their kids is a good thing when it is, in fact, the polar opposite: a bad thing. I don't know how much time a lot of doctors and counselors have in dealing with this subject but I feel that if you can explain to parents why it is so unhealthy for them to encourage or allow their kids to overeat you can make the case. If parents who love and care about their kids, and I am sure they're few that don't, can be made to understand they are "killing them with kindess" and are condeming them to early onset of diabetes, hypertension, cardiovascular disease and obstructive sleep apnea .....then you're doing a good thing.

I read some of the responses here to my co-worker, filtered through me to smooth out some of the brusque style that these discussion always have. She claimed the effect for herself, that she did not have a weight problem until she had heart surgery at the age of four. Yes, I know: I have no way to evaluate how anyone would know whether or not a child had, or had a propensity for, weight issues at that age. She also has sleep apnea herself and uses a CPAP. Which I can empathize with, having sleep apnea myself, but after tests it was determined it was not bad enough to require air being forced into my lungs while asleep. Like everyone else it helps her, but its a cumbersome sort of thing to deal with. In fact, I doubt I would deal with it at all, being a nigh-time bruxer who invariably spits out my night guard. I can only imagine the thrashing a CPAP would get.

In any case, the variables stack up, and it's obvious that mom and the child are dealing with far more issues, and therefore more variables, than anesthesia alone. That would include diet, lifestyle and possible genetic predispositions.

I suspect parents adhere to this search for a cause rather than admit that their child's weight problem -- or autism, or leukemia, or what have you -- is either directly their doing or, even more insidious, something they inadvertently and unknowingly passed on to their child through their own genes.

In which case this search for some cause like anesthesia, vaccination, power lines or whatever, is a sad form of "credo consolans": They believe because it's (perversely) comforting.