Teens and extreme obesity: Is it time for weight loss surgery?

America, we have a problem!  Nine percent of 12- to 19-year-olds have morbid or extreme obesity. Morbid obesity is defined as a Body Mass Index of greater than 40. For a 5’4” 17-year-old girl, this is a weight greater than 235 pounds; and for a 5’9” 17-year-old boy, this is a weight greater than 275 pounds. 

These young people are developing serious and complicated  “adult” medical problems — problems they probably don’t even understand — such as hypertension or high blood pressure, hypercholesterolemia or high cholesterol, diabetes or high blood sugar, polycystic ovary syndrome (a female hormonal and metabolic disorder), obstructive sleep apnea or blocked breathing, and nonalcoholic steatohepatitis or fatty liver disease.

This everyone understands: most morbidly obese teens remain so as adults, and they have a shorter life expectancy than normal. They may lose from 6.5 years (BMI of 40-44.9) to 13.7 years (BMI of 55-59.9) of life.

What about bariatric surgery…for teens? I’m not a surgeon, but I believe that physicians and parents may need to consider this option. The most common types of operations being performed on adolescents are the Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and laparoscopic sleeve gastrectomy (LSG). 

RYGB: A small stomach pouch is created at the top of the stomach and the pouch is connected to the mid-jejunum area of the small intestine. The small pouch greatly limits the amount of food that can be consumed. Food flows directly from the pouch into this part of the small intestine. The main part of the stomach continues to make digestive juices and is reattached farther down the small intestine. Because food bypasses a portion of the small intestine, fewer calories are absorbed.

Is there evidence that RYGB helps teenagers? Yes. Two recent studies—one that followed up with those who had teen bariatric surgery after five years, and another one which compared weight gain between obese teens who had surgery to obese teens receiving non-surgical treatment—showed a significant reduction in BMI at one year and significant declines in high blood pressure, high cholesterol, and Type 2 diabetes.

LAGB: A band containing an inflatable balloon that is placed around the upper part of the stomach. A small stomach pouch is created above the inflated band and allows only a very narrow opening to the rest of the stomach. A port is placed under the skin and is connected by a tube to the band. By injecting or removing fluid through the port, the balloon can be inflated or deflated to adjust the band. LAGB restricts the amount of food that the stomach can hold, so fullness occurs earlier.

Is there evidence that LAGB helps teenagers? Yes. One study of 87 adolescents aged 14-19 years who had LAGB found an average weight loss at six months of approximately 27 pounds.

LSB: Part of the stomach is separated and removed from the body. The remaining section of the stomach cannot hold as much food. 

Is there evidence that LSG helps teenagers? Yes again. In a review of 108 patients aged 5-21 years who had LSG, an average of 29 percent of total weight was lost after three months, 48 percent after six months, 61 percent after 12 months, and 62 percent after 24 months. The teens also experienced improvement in high blood pressure, high cholesterol and Type 2 diabetes.

Teens and morbid obesity: Is it time for weight-loss surgery? It’s time to find out. A teen who has a BMI of 40 or higher and is physically mature may be a candidate for surgery. Talk with your teen’s primary healthcare provider to learn more about the benefits, as well as the short- and long-term risks. Parents and teens need to understand that if they have surgery, it is only one step in losing weight. Teens will also need to build a new lifelong, healthy relationship with food and exercise. Surgical candidates will need to have the support of their family, the support of a team of experts, and the motivation to make lifelong changes. There’s no bypassing this.


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