Adolescent Bariatric Surgery
by Mexico Bariatrics
Adolescent bariatric surgery is a drastic, life changing — and controversial — decision. Childhood and adolescent obesity is an epidemic in the United States. The latest statistics from the U.S Surgeon General are sobering. They show that more than 12.5 million children and adolescents aged 2 to 19 are overweight.
And these numbers are on the rise. As a result, growing numbers of children and teens are at increased risk for diseases traditionally seen only in adults, including heart disease and type 2 diabetes.
Our surgeons will recommend this surgery if a child’s weight poses a greater health threat than the potential risks of the surgery. Risks of adolescent obesity include diabetes, high blood pressure, joint problems, liver problems, lung and breathing issues and increasing pressure in the brain that can cause vision impairment or blindness.
Bariatric Surgery an Answer to Adolescent Obesity
Weight loss surgery is not a panacea for obesity in teens. There are many unknowns. No studies document the long-term effects of weight loss surgery on a child’s future growth and development. What’s more, weight loss surgery does not guarantee that an adolescent will lose all of his or her excess weight and/or keep it off long-term. Weight loss surgery also doesn’t replace the long-term need for a healthy diet and regular physical activity.
If weight loss surgery is deemed an option for an adolescent, he or she should be referred to centers with multidisciplinary weight management teams. These teams should include specialists in adolescent obesity evaluation and management, such as psychologists, nutritionists, physical activity instructors and weight loss surgeons.
Health Problems Teen Obesity
Almost all morbidly obese teens have at least one serious obesity-related health problem.
- Fatty Liver Disease – 38% of obese children and adolescents have fatty liver disease.
- Hypertension – obese adolescents are about three times more likely to develop hypertension than non-obese adolescents.
- Metabolic Syndrome’s prevalence increases with the severity of obesity. Fifty percent of severely obese adolescents have metabolic syndrome.
- Orthopedic Injuries – Spinal complications, slipped capital femoral epiphysis, Blount disease and acute fractures have all been associated with teenage obesity.
- Sleep apnea – Obstructive sleep apnea and obesity hypoventilation syndrome are serious consequences of obesity in teens.
- Type 2 diabetes, which leads to adverse heart-related risk factors is correlated with teen obesity.
Teen Candidates for Bariatric Surgery
Exactly when an adolescent should undergo weight loss surgery is controversial. It depends on the severity of obesity-related health problems faced by the individual patients. This individualized decision should be made on a case-by-case basis with the medical team.
According to guidelines set forth by the American Academy of Pediatrics in 2004, adolescents under consideration for weight loss surgery should:
- Have failed six or more months of organized attempts at weight management. This should be determined with the assistance of a doctor.
- Have attained or nearly attained physiologic or skeletal maturity. This generally occurs at age 13 or older for girls and at age 15 or older for boys.
- Be severely obese, with a body mass index (BMI) of greater than 40, with serious obesity-related problems; or have a BMI of greater than 50 with less severe obesity-related problems. (Other organizations, including the American Society for Metabolic and Bariatric Surgery, have less stringent weight criteria for teens, due to the severity of medical problems that obese adolescents now face.)
- Be committed to comprehensive medical and psychological evaluations that should occur before and after surgery.
- Agree to avoid pregnancy for at least one year after surgery. Pregnancies are safe after weight loss surgery, but reliable contraception should be used for at least the first year after the operation due to increased risk to the developing fetus posed by the rapid weight loss. After the period of rapid weight loss is over, pregnancies should be carefully planned and monitored.
- Be capable of and willing to adhere to a strict bariatric surgery nutrition program following your operation. For example, after gastric bypass surgery, patients must consume a very low-calorie, low-carbohydrate diet with more than 0.5 grams of protein per kilogram of body weight per day. Daily multivitamins, as well as supplements of key nutrients such as calcium, vitamin B12, folate, thiamine and iron (for menstruating females), may also be needed.
- Provide informed consent to surgical treatment.
- Demonstrate the ability to make sound decisions. Age is not necessarily the limiting factor here.
- Have a supportive family environment.
Tests for Weight Loss Surgery Eligibility
Along with a complete physical exam and counseling, your doctor will run several tests that can help determine whether the weight poses a greater health threat than the potential risks of weight loss surgery. They include:
- Fasting glucose and hemoglobin A1C measurement to look for blood sugar anomalies that suggest type 2 diabetes.
- Liver function tests.
- Lipid profile tests to see if blood cholesterol levels are elevated.
- Complete blood counts.
- Thyroid function tests.
- Pregnancy tests for female patients.
- Screening for nutrient deficiencies.
- Sleep study (polysomnography) for adolescents with sleep apnea (one or more pauses in breathing or shallow breaths while you sleep).
- Bone age assessment to document the degree of skeletal maturity.
Choosing The Bariatric Surgery Procedure
Exactly which weight loss surgery is best for teens is not yet known. Both the Roux-en-Y gastric bypass and adjustable gastric banding have been effective in treating adolescent obesity.
During gastric banding, an adjustable band is placed around the stomach to restrict food intake. In contrast, the Roux-en-Y-gastric bypass creates a small stomach pouch to curb food intake by stapling a portion of the stomach. Then a Y-shaped part of the small intestine is attached to the stomach pouch so that food can bypass the duodenum (the first part of the small intestine, located between the stomach and the middle part of the small intestine, or jejunum).
Unlike gastric bypass, which involves cutting or stapling the stomach to permanently decrease its size, the Lap-Band is adjustable and, if necessary, removable.
The rate and amount of weight loss also differs. The weight loss from gastric bypass is very rapid, occurring in the first nine to 12 months. It tends to plateau after 18 months. Weight loss with gastric banding, however, is more gradual. Adolescents who undergo gastric banding lose about five to 10 pounds a month. Teenagers do lose weight faster with gastric banding compared with adults who undergo this weight loss surgery, possibly because they are more motivated and receive more positive social feedback.
Life After Bariatric Surgery
The journey is not over after weight loss surgery. Far from it. Some teens may need body contouring surgeries to get rid of the excess skin and flab that remain after massive weight loss. Unlike their peers, teens who have undergone weight loss surgery must be hypervigilant about what they eat, when they eat and how they eat it. Teens often want to fit in, and such regimented eating may make them stand out.
Long-term medical and psychological follow-up is also necessary after weight loss surgery. It is no quick fix. Weight loss surgery involves a deep commitment and intensive follow-through. In the right adolescent, however, weight loss surgery can improve overall quality of life and self-esteem.
Come for Consultation
To find out more about adolescent bariatric surgery, including the benefits, risks, and possible complications, contact us today. Our doctors are widely recognized and highly respected weight loss surgeon and has performed more than 6,000 weight loss surgery procedures. He will provide you with an extensive examination and consultation to discuss your candidacy for adolescent bariatric surgery.
If you’d like to learn more about adolescent bariatric surgery, please contact us. We look forward to having a conversation with you about this exciting medical advance!