A recent study by Michigan Medicine researchers published in JAMA Otolaryngology-Head & Neck Surgery has debunked the long-standing assumption that adenotonsillectomies in children with mild sleep-disordered breathing result in undesirable weight gain. The research, an exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), found no significant link between the surgical removal of tonsils and adenoids and increased weight gain in this patient population.
The PATS trial included 458 children with mild sleep-disordered breathing, who were randomized into either an adenotonsillectomy group or a "watchful waiting" group. While the overall PATS results indicated that adenotonsillectomy did not significantly improve primary neurodevelopmental outcomes, it did show improvements in secondary outcomes like symptoms, blood pressure, and quality of life. This latest analysis specifically addressed concerns about weight gain as a potential side effect.
Challenging Previous Assumptions
"For many years, tonsillectomy causing weight gain in kids was a common assumption based on early studies with little control data," said Dr. Erin Kirkham, pediatric otolaryngologist at U-M’s C.S. Mott Children’s Hospital and lead author of the study. The researchers suggest that previous observations of weight gain after adenotonsillectomy may have been misinterpreted due to the natural weight gain trajectory of overweight children and the inclusion of underweight children experiencing "catch-up" growth.
Key Findings on Weight Gain
The study defined undesirable weight gain as underweight or normal-weight children becoming overweight after 12 months, or already overweight children continuing to gain weight during the same period. After 12 months, undesirable weight gain occurred in 32% of the adenotonsillectomy group (120 children) and 27% of the watchful waiting group (101 children). However, regression analysis revealed no significant association between adenotonsillectomy and undesirable weight gain.
Implications for Clinical Practice
"The upshot is that if you're a sleep specialist—or an otolaryngologist considering taking out a child’s tonsils—you don't have to worry families as much by saying, ‘There's an obesity epidemic, and if you choose surgery, it could increase the risk of obesity for your child,’" said Dr. Ronald D. Chervin, director of the Sleep Disorders Center at U-M and senior author on the paper.
The authors emphasize that while adenotonsillectomy may not be the cause of unwanted weight gain, nearly a third of participants did experience it. This highlights the importance of clinicians encouraging healthy weight management strategies for overweight children with mild sleep-disordered breathing.
A prior study from the same research team, published in Sleep Medicine in 2021, also concluded that "Adenotonsillectomy may not be an independent risk factor for undesirable weight gain in children."
