Weight-loss surgery for teens?
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Weight-loss surgery for teens?
Gary A. Emmett, M.D., Pediatrics Professor- Thomas Jefferson Univ. & Director, Hospital Pediatrics- TJU Hospital
by Gary A. Emmett, M.D.
The obesity ”epidemic” is now old news, but it is scaring the heck out of medical practitioners since we know that the very heavy children we are now seeing will have chronic illnesses such as Type II diabetes, hypertension, fatty liver, gall bladder disease and chronic hip problems 20 to 30 years earlier than their parents did.
This change in disease patterns will change society. Although all economic levels and all racial and ethnic groups are affected by trend toward being overweight, the Centers for Disease Control and Prevention reports that risk may be higher for kids from lower-income families. And University of Pennsylvania childhood obesity experts report that nearly a quarter of Mexican American adolescent boys were obese in 1999–2002, compared to 19 percent of African Americans and 15 percent of whites. And among teen-age girls, 24 percent of African Americans, 20 percent of Mexican Americans, and 13 percent of whites were obese.
The medical resources needed to treat the “metabolic syndrome (the sum of the side effects of chronic obesity)” will soar, permanent disability will occur at younger ages and even life expectancy could start going down again.
In addition, although reasonable diet and regular exercise will usually prevent unhealthy weight, the same regime is not that good for losing extra weight. The body defends its extra weight as it awaits for the next famine: The hormone ghrelin rises, giving us a big appetite, while the hormone leptin decreases and so does our metabolic rate and our ability to mobilize and lose fat, while the compound Peptide YY increases so we can never feel satisfied about eating enough.
Sometimes drastic measures are needed and I would like to report on a wonderful presentation I attended this week on Bariatric (means pertaining to overweight) Surgery for Adolescents.
Bariatric surgery is only used in adolescence for remarkably obese individuals (often 2 to 3 times the suggested healthiest weight). Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., has a model program that is keeping detailed data on the outcomes of weight-loss surgery in young people.
There are three common surgeries for weight reduction and only the two with the least side effects are done on these teenagers: Stomach banding and sleeve gastrectomy. These two are reversible. To even be considered for the duPont program a patient must have morbid obesity (at 5 foot 4 inches, a weight of 240 pounds or more qualifies as morbid obesity, for example). The patient must have already failed at conventional weight loss, be able to understand what they are agreeing to the treatment, and be emotionally able to cope with major surgery, healing, following a careful diet – and with dropping to and maintaining a normal weight.
Why would patients and their parents resort to surgery with all its possible complications? For extremely overweight young people, surgery can reverse high risk for serious, life-threatening health conditions including:
- Diabetes – which also increases risk for heart disease, stroke, vision problems, kidney failure, nerve damage and even amputation.
- Fatty infiltration of the liver – a common “side effect” of overweight, a fatty liver boosts risk for diabetes, heart disease and more
- High blood pressure and high cholesterol – both of which boost risk for heart disease and stroke
- Verbal abuse and low self-confidence – returning to a healthier weight can increase self-esteem and help a young person enjoy social activities at school and in their community
But surgery doesn’t fix everything:
- It does not make the patient thin. These patient lose fairly consistently about 30 to 40 percent of their excess weight – about 40 to 50 pounds in our 240-pound patient above – by exercising and eating carefully in the weeks, months and years after surgery.
- It does not stop gall stones and the gall bladder disease if the patient is prone to this problem
- Unless you are willing to work at healthy eating and regular exercise and stick with it, it does not keep the weight off entirely. The average patient who does not change their lifestyle gains back about one-third of the lost weight. A few others use it to lose more weight and get down to their recommended weight for height and build. A rare few even find ways to overeat after the surgery and gain all the lost weight back.
The average teenager in the duPont study had lost 65 pounds two years after surgery (weight loss ranged, at two years, from a high of 130 pounds lost to nearly no pounds lost in those who regained weight they’d taken off in the months after the procedure.) There were also important health benefits. Most became more sensitive to insulin, the hormone that tells cells to absorb blood sugar. That’s important because insulin resistance raises risk for type 2 diabetes. They also had less general, body wide inflammation, another risk for diabetes. And in a test of fitness – the six-minute walk test (that I am currently doing research on this with normal-weight children) — these young people improved by 15 percent, walking 200 feet further.
Although this surgery seems to help the most obese adolescents a great deal in most cases, the important idea for society is to prevent the obesity with a healthy diet and regular exercise for every child and adult. A good day is still when one reads for an hour and plays hard for a hour!
Gary A. Emmett, M.D., Nemours Pediatrics, Thomas Jefferson University Hospital, Jefferson Medical College, has been a primary care pediatrician in South Philadelphia and Center City since 1979.
Shame on you guys for posting an article that doesn't have factual information in it! Gary Emmett MD states only 2 weight loss surgeries are performed on youth. This is wrong! I know of many who have also had Gastric Bypass and the Duodenal Switch (BPDS) ... Also ... um can you explain Doc how a sleeve gastrectomy is "reversible" ? More than half of your stomach is REMOVED. Just like someone who has stomach cancer. How is that reversible! I wish I could find an email for the good doctor to set him straight!— winelover215- Yeah, dumb-a** amerikans don't have the guts to tax soda and the other garbage that is at the root of this, and even more nauseating is they are completely ignorant (and willfully so) that eating healthy in most city neighborhoods is nearly impossible. I'd like any of these brainiacs commenting here to head down to Kensington and try to find a tomato or fresh lettuce. Oh but it's the kids fault, it's the parents fault there isn't a green vegetable within a mile. A bag of chips and 64 oz soda? Available on every street corner.— CiceroSpuriousDeodatus
- come on, people! the surgery does not fix the habit that led to the surgery.
if you want to lose weight, and increase your metabolism by as much as 25% (according to Dr. Oz), you need to do a meal replacement program.
i lost 12 lbs so far and I've saved money on what has become the #1 health and fitness platform in North America. at $1.87 per meal, anyone can lose weight and save money on grocery bills. drop me a line at findpatrick@yahoo.com to learn more. but only if you want to meet your health goals...— p@trick - I've never had a weight issue, but I know plenty of people who do. These kids have parents who have created such an uphill battle for them it is a shame. If you start when kids are young with healthy eating and exercise habits, it will benefit them for the rest of their lives. Those blaming the kids for being "entitled" - what does that even mean? When you are a child, your parents decide what to buy and eat. The blame falls squarely on their shoulders. Once bad habits are formed and food becomes a crutch, it is extremely difficult to get out of that cycle.— lulu
- I don't think a penny of taxpayer dollars should be spent on surgery for obese kids (or adults) absent some underlying medical condition. On the other hand, it drives me nuts that the Govt. gives billions in to big Agriculture (with their hundreeds of lobbyists and millions in campaign contributions) to produce high frucose corn syrup. In poor neighborhoods (or anywhere really) kids can find cheap (subsidized) junk food on every corner, but healthy food, if they can find it at all, is very expensive.— bob19103
- The answer: moderate exercise, more veggies replacing meat intake, stop with the snacks and soft drinks and LESS time sitting at the dinner table— Chemist1524
Comment removed.- It's fairly obvious in my suburban neighborhood. The kids who play outside most of the day and eat more home-cooked food are thin. The kids I never see outside (except walking to the bus stop) and whose parents seem to have Domino's on speed dial are obese. Yes, it is that plain to see.
The kids who have the closest thing to a legitimate gripe about it being hard to maintain a healthy weight are the ones who live in neighborhoods that are unsafe for play or that have no healthy grocery choices anywhere nearby.— JQ - Comment removed.
- "The average patient who does not change their lifestyle gains back about one-third of the lost weight."
The problem with quick fixes like this, is that the patient doesn't learn anything. The best way to encourage healthy weight loss is teach them to modify their behavior, actually develop will-power. The human body is an amazing thing, it can adapt. If you have the will power to no longer eat beyond the point of feeling not hungry, then your body will adapt and it will require less food to satisfy you.And another thing, it is not just quantity, but also the quality of food food that you are eating. If you get a stomach band, but still eat fast food every meal, guess what? You will probably still be fat. This falls largely on today's parents who are too afraid to say "no", yet are constantly in a hurry and dont have time to prepare an actual healthy meal. (HTML deleted)— jpatt6 - Who pays for this surgery? I need to lose 10 pounds so I have reduced what I'm eating, eliminated most junk food and am exercising 30 minutes every night. How would you choose surgery over that?— neddyflanders
- Comment removed.
- Proper eating does wonders. Parents should set the example.— dogman5
- The problem is more so a cultural issue of bad dieting and a lack of exercise. I experienced a sudden tightness in my pants this year and had to make a decision, either get off my rear and change my eating habits or buy new pants and continue my unhealthy life style. I chose to diet and exercise. 23 pounds later I can easily fit into my size 36 pants again. I feel good about my accomplishment because I worked hard for it and understood what it would take to achieve my goal, hard work and dedication. Children are not taught how to be disciplined enough to diet, more so they are not taught how to eat healthy at home, nor are they made to exercise. Put down the videos games, turn off the tv and go outside and play, during school join the track team or play basket ball or baseball/soft ball. In this microwave society to many youths want or expect things to come quick and easy like a Mc'Donalds happy meal. Children in our culture lack a work ethic and this story demonstrates just that. Exercise, eating properly and maintaining a proper diet is the cure, not costly surgery (ridiculous).— Eaglehaslanded
- Children are not taught how to eat healthy at school nor are they expected to exercise at school. They are not taught to exercise and how to be active. Why am I pushing it off on the school's? Because 9 month's out of an year and five day's a week and eight hour's a day is where they spend their time. That is the biggest influence in their life's. Not that the parent's are in the mix too. But school in a bigger influence with all the time that they spend there. And video games are mixed up in there too.
Addressing your surgery opinion. You don't know what you are talking about. There is such a thing as genetic's. That is a real problem. That has to do with gene's. I have recently came down with some genetic problem's. It is hard to comprehend that a little gene can affect your body and life. Look up and study genetic's. I can't spell it but I am suffering from it. ; }— smorevette - Comment removed.
- Should people who look like you be removed from their homes simply because of the way you all look? — Dolly92748
