If you know a seriously obese teenager then you’ve probably seen toll the excess weight has taken on his or her life. Obesity can severely limit mobility and activity in general; teasing by peers is common, as is low self-esteem and depression. In many cases, the teen’s schoolwork suffers as well. But how do you know if your teenager is ready for weight reduction surgery?
When we eat, swallowed food passes into the stomach, where gastric juices further break down the food. Nutrients and calories are absorbed in the small intestines, then the large intestines take over; it’s here that waste products are collected and feces are formed.
In a gastric bypass procedure, the stomach is reduced using either surgical staples or an inflatable plastic band filled with saline. The top part of the stomach is left intact – a small pouch about the size of an egg. This new stomach can only hold about an ounce of food, and the patient feels full and satiated very quickly. In addition, fewer calories are absorbed because most of the intestines are bypassed.
This tiny stomach pouch is surgically attached to the middle of the small intestine, and food is redirected past the larger stomach. The larger stomach and intestine portion is then attached further down the intestines. Once completed, the intestines essentially form a “y” shape, and that’s why the procedure is known as Roux-en-Y gastric bypass.
Surgery can be performed via a large incision, or laparoscopically. The latter is a minimally invasive approach in which the physician makes several small incisions, and may use three or more laparoscopes (tiny, thin tubes with video cameras attached). All movement is viewed on a monitor. This approach offers better pain management, a shorter hospital stay, and reduces the risk of infection.
According to the American Society for Metabolic & Bariatric Surgery (ASMBS), the typical candidate for gastric bypass surgery has a body mass index (BMI) of 40 or higher, is 100 pounds or more overweight, and is classified as morbidly obese, or has a BMI of 35 to 39.9, and has a serious weight-related health problem such as type-2 diabetes or high blood pressure.
Special Concerns for Teens
Bariatric surgery involves a team of experts: physicians, a nutritionist, a psychologist, and an exercise specialist. All gastric bypass surgery candidates go through a rigorous screening process to determine mental and physical fitness.
“The compliance issue with weight loss surgery is critical” says Terrence M. Fullum, MD, FACS, medical director of Bariatric Surgery at Upper Chesapeake Health (UCH) in Havre de Grace.
When faced with a young candidate for WLS, UCH takes into account a patient’s school performance, grade point average, maturity level, self esteem, whether or not they have a one to three year plan for their lives and, most importantly, their relationship with their parents or caregivers. Patients are required to keep food logs and participate in support group activities. Preparation is so intense because “behavior modification is important. With pediatric patients we see more food addictions,” says Dr. Fullum. The youngest patient he’s worked with was 17, but in the U.S. patients as young as 14 have had this surgery.
“If the child has researched the topic and takes ownership, that is someone who’s prepared for surgery. The parent may give informed consent, but the child really needs to understand the process” says Dr. Fullum.
A 2004 study published in the Journal of the American Medical Association, detailed improvements seen by bariatric surgery patients. Specifically, type 2 diabetes went into remission in 77% of those studied, high cholesterol levels were reduced in over 70%, and high blood pressure and sleep apnea were eliminated in 62% and 86%, respectively.
One aspect of bariatric counseling is managing expectations. “These teens want to look like everyone else. They over-exaggerate the significance of weight loss, even if it’s just 50 pounds,” says Mary Jo Rapini, a psychotherapist in private practice whose work with gastric bypass patients is featured on the Discovery Health television show “Big Medicine.”
Often after surgery and a large weight loss, a teen will wear clothing that is a little “too skimpy” or fashions that are inappropriate for his or her size, because of their eagerness to fit in. Some teens are bewildered when they’re still teased by peers despite their weight loss. “They want to dress too ‘normal,’ too soon. Teens want that immediacy more than adults,” says Ms. Rapini.
According to Ms. Rapini, compared to adults, teen gastric bypass patients are “more optimistic. Counseling is easier with them, and teens are much happier with their results. They fit back into society easier.”
Unlike most adult patients, post-op counseling will include a teenager’s parents and siblings. If the parents are also obese, Ms. Rapini recommends food and exercise changes that will benefit the entire family. If the teen’s parents are thin, they may be “enablers,” who substitute food for affection, or use food as a reward. She will advise these families on healthier ways to be supportive and caring. However, even thin parents may not exercise or have good eating habits, and changes are encouraged. “The teen is often a catalyst for the whole family,” she says.
Gastric bypass surgery outcomes between adolescents and adults don’t differ significantly. “Both teens and adults vary in their motivation levels and the discipline with which they stick to the program. But weight-loss surgery has been successful for the vast majority of both groups,” said Kent Sasse, MD, MPH, FACS of the Western Bariatric Institute in Reno, Nevada, and author of the forthcoming book, Outpatient Weight-Loss Surgery: Safe and Effective Weight Loss with Modern Bariatric Surgery.
Outcomes “may differ for teens because of the opportunities that weight loss can create for them. For example, young people who lose a significant amount of weight often find that they become more successful socially and academically at this important time in their lives. So while the weight loss may be similar to adults, the impact on a teen’s life may be greater,” he continued in an emailed statement.
Bariatric surgery can cost about $25,000 or more, depending on the surgical procedure chosen, location, experience of the medical team and the post-op services needed. Some insurers will cover all or most of the cost, particularly for morbidly obese patients, where surgery may be their best, last option.
If you or a loved one is considering bariatric surgery a good place to start your homework is to discuss this option with your health care provider, and visit the AMSBS website (asmbs.org) for more information.
By Deeanna Franklin Campbell