For Obese Teens, Bariatric Surgery May Be Drastic but Vital
(HealthDay News) Weight-loss surgery may be gaining traction as a viable treatment for obese teenagers, particularly those who are beginning to show the detrimental health effects of morbid obesity.
Teen obesity has become a serious public health concern in the United States, with recent research finding that nearly one in every four teenagers is obese, according to the U.S. Centers for Disease Control and Prevention. Despite this, doctors have been loath to perform weight-loss surgery -- also called gastric bypass and bariatric surgery -- on teenagers, though it's become a common and effective method of weight loss in adults.
But new studies evaluating the merits of weight-loss surgery for teenagers have provided fresh evidence that such a drastic step may be needed to head off a lifetime of obesity and illness.
"There's certainly a feeling among health-care providers and families that little Johnny is really getting heavier and heavier, but all he needs to do is put his mind to it and he can reverse this," said Dr. Thomas Inge, director of the Center for Bariatric Research and Innovation at the Cincinnati Children's Hospital Medical Center. "But that is clearly not working for some kids. Until you bring up the option of bariatric surgery for those patients, you haven't done your job as a doctor."
Inge served as lead author on a study that argued for the use of weight-loss surgery earlier rather than later in children who are becoming "super obese." The study of 61 teens found that kids with an incredibly high body mass index (BMI) lost more than one-third of their weight after gastric bypass but were still heavy enough to be considered morbidly obese. BMI is a measurement that takes into account weight and height.
"We are seeing patients still in 2010 who are coming to us routinely with a BMI of the high 50s and 60s and 70s," Inge said. "When we can get to these kids with BMIs in the 40s, we can have a decent chance of turning around their morbid obesity. When BMIs are higher than that, very often we can get their weight down, but they're still going to remain morbidly obese even after treatment. Once they get into the high 50s and beyond, I think we've done the kid a disservice."
Another small study, involving 50 severely obese Australian teenagers, found that those who underwent gastric banding surgery were much more successful in losing weight. The target goal of losing more than half their excess weight was achieved by 84 percent of the teens who went through weight-loss surgery, but only 12 percent of the kids who tried dieting and exercise.
Bariatric surgery for children is currently recommended primarily for those who either have a BMI of 35 or above and have major health problems related to their obesity, and for children with a BMI of 40 or above who are showing early signs of obesity-related health problems, Inge said.
Not every child meeting those criteria would be a good candidate for weight-loss surgery, however.
Because bariatric surgery can deplete the body of key nutrients needed for healthy development, children should have already undergone the majority of their linear growth, said Dr. Lori Laffel, chief of the pediatric, adolescent and young adult section at the Joslin Diabetes Center and an associate professor of pediatrics at Harvard Medical School.
"Their bones need to be as close as possible to what they will possess in adulthood," Laffel said. "You don't want to compromise opportunities to attain maximum bone density and maximum bone mass."
That would limit weight-loss surgery for the most part to girls older than 13 and boys older than 15, Laffel said.
The teenager also should display a certain level of emotional maturity and have a supportive family, Laffel and Inge said. Weight-loss surgery places very strict dietary requirements on people. Certain foods are restricted or completely banned, and dietary supplements become essential to make sure the person receives sufficient nutrients, vitamins and minerals. If the kids aren't capable of meeting these requirements or do not have parents to help them by buying the right foods and making sure they eat them, then the surgery should not be undertaken, they said.
Laffel stressed that prevention and lifestyle choices should properly remain the first line of treatment when it comes to teen obesity.
"You want maintaining a healthy weight to become an effort for life," Laffel said, noting that kids who undergo bariatric surgery might not understand the amount of healthy eating and exercise that will be needed to keep off the weight they shed.
At the same time, there's no denying that weight-loss surgery can help kids who are otherwise doomed to a lifetime of obesity and chronic illness, she said.
"There's no question this gives you a remarkable jump-start," Laffel said. "As the procedures get simple and safer, I think this will be more often considered."
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SOURCES: Thomas Inge, M.D., Ph.D., associate professor, surgery and pediatrics, University of Cincinnati College of Medicine, and director, Center for Bariatric Research and Innovation, Cincinnati Children's Hospital Medical Center, Cincinnati; Lori Laffel, M.D., M.P.H., chief, pediatric, adolescent and young adult section and investigator, genetics and epidemiology section, Joslin Diabetes Center, and associate professor, pediatrics, Harvard Medical School, Boston; U.S. Centers for Disease Control and Prevention (www.cdc.gov)