Like adults, lots of teens wish they could change something
about themselves. Fortunately, in some cases - take hair, for
example - that's pretty easy to do. Kids can grow it long, cut
it short, and if they don't like it, a new look is just a quick
snip or a few skipped haircuts away.
But certain things are not easy to change. For the 1%-2% of U.S.
teens who are severely obese, losing those extra pounds can be one
of them. For some, sticking to a doctor-approved diet and exercise
plan is enough to lose enough weight to improve their
obesity-related complications, such as diabetes, heart disease, or
sleep apnea. But for others, even major lifestyle changes
aren't enough.
In these cases - where regular weight loss attempts have failed
and medical problems persist - weight loss surgery or bariatric
surgery might be an option.
About Bariatric Surgery
Bariatric surgery had its beginnings in the 1960s, when doctors
first noticed that people who had portions of their stomach or
intestines removed due to ulcers or cancer tended to lose a lot of
weight after surgery, regardless of what they ate. Doctors soon
realized why: Not only could a smaller stomach hold less food at
one time, but a shorter intestine couldn't absorb as many
calories and nutrients for the body to use.
The field of weight loss surgery has come a long way since then,
but is still based on those same two principles:
-
Restriction:
restricting the amount of food a person can comfortably eat by
reducing the size of the stomach
and/or
-
Diversion:
diverting food around a portion of the small intestine (usually
about 2 feet) so that less is absorbed by the body. Diversion
also changes the levels of hormones and enzymes in the digestive
tract that signal hunger and fullness, so a person feels fuller
sooner.
Gastric Bypass vs. Gastric Banding
Today, there are two main surgical techniques for weight loss:
gastric bypass and gastric banding.
Gastric bypass
(also called "Roux-en-Y" gastric bypass) is more common,
accounting for 80% off all weight loss surgeries. It involves
creating a small pouch, about the size of an egg, at the top of the
stomach using surgical staples or a plastic band. This pouch, which
will serve as the "new" stomach, is then connected
directly to the middle part of the small intestine (the jejunum).
So not only will the pouch hold a lot less food - just 1 cup as
opposed to the 8 cups or more that a normal-sized stomach can hold
after stretching to accommodate a really big meal - the food will
also bypass the larger part of the stomach and the upper part of
the small intestine (the duodenum).
The pros of gastric bypass are that it has a high rate of
success and a longer track record than gastric banding.
The cons are that even though it can often be done
laparoscopically (using a few small incisions and a camera to guide
the doctor's movements instead of opening up the abdomen), it
still involves cutting the intestine - which makes it a more
complex procedure than banding, and associates it with more
complications and a longer recovery time. The lack of intestinal
absorption also tends to cause vitamin deficiencies and, unlike
gastric banding, the procedure is not reversible.
Gastric banding
also works by decreasing the amount of food that can be comfortably
eaten. It does this with the help of an adjustable silicone device
(called the Lap-Band) placed at the very top of the stomach to
create a small pouch. Like bypass, this band reduces the size of
the stomach and makes people feel fuller sooner. Unlike bypass,
though, banding does not interfere with food absorption in the
small intestine.
The pros of gastric banding, which is done laparoscopically, are
that it has a lower complication rate than the more invasive
gastric bypass, and vitamin deficiencies are rare because the
intestine is not affected.
The band can be tightened or loosened to increase or decrease
weight loss. Doctors adjust the band at periodic visits by
inflating or deflating it through a port placed under the skin. The
band may even be removed entirely if necessary, allowing the
stomach to return to its normal size.
The cons are that it may not initially take off as much weight
as surgical bypass - which can help people loose 60 to 70% of their
excess body weight - and it may require replacement surgery at a
later date. The Lap-Band is not an approved device for people
younger than 18, though clinical trials are underway.
Who Is a Candidate?
Figuring out if a teen is a candidate for weight loss surgery is
a big decision that requires a team approach, including the teen,
his or her family, doctors, nutritionists, and psychologists.
Generally, a teen candidate's body mass index (BMI) - the
number calculated from a person's height and weight that
measures body fat - should be 40 or higher, which constitutes
severe obesity. A teen with a slightly lower BMI (35 or higher)
also may be a candidate for surgery if suffering from potentially
life-threatening medical complications, like diabetes or heart
disease. He or she must also be physically mature, which generally
means at least 13 for girls or 15 for boys (though the average age
of the surgery is 16).
The team will consider other things, too: Is the teen healthy
enough for surgery? Have other weight loss options failed? Does he
or she understand what's involved? Weight loss surgery is
serious stuff - both physically and emotionally. In fact, having
the operation is only one step in losing weight. Teens need to
cultivate a new relationship with food by eating very small
amounts, chewing thoroughly, and evenly spacing out food
consumption throughout the day. For many, adjusting to this whole
new way of eating and living - in a "new" body - can be
overwhelming.
That's why doctors tend to take a conservative approach when
it comes to weight loss surgery for teens, and only recommend it
for those who have what it takes to make it a success: the
motivation to make lifelong changes and the support of their family
to help them do so.
Risks and Side Effects
Weight loss surgery, like any surgery, does come with risks.
Uncommon but serious risks include:
- bleeding
- reaction to anesthesia
- infection at the incision site
- a leaky stomach or intestine that can lead to peritonitis, an
infection of the stomach cavity
- a blood clot in the lung
- bowel obstruction
Other side effects are more common and not quite as serious, but
still unpleasant nonetheless. For example, many people who've
had weight loss surgery experience pain, vomiting, diarrhea, and
acid reflux after eating - especially if they eat too much or too
quickly. This is why they have to change their approach to
mealtime. If they don't, not only will they continue to feel
sick, but in time they can regain weight.
"Dumping syndrome" is a common problem associated
mainly with gastric bypass. This is when food moves too quickly
through the stomach and intestines, causing nausea, weakness, and
sweating. Because dumping can be made worse by eating high-sugar or
high-fat foods, teens need be especially careful about the types of
food they eat as their bodies get used to a different mode of
digestion. This can be especially difficult for teens, since fast
food and sugary snacks can seem like their own food group at this
age, and the pressure to fit in can make it harder to make good
nutritional choices.
And last but not least, there are the emotional side effects.
For example, it can be hard for some teens to figure out a new,
healthy relationship with food, especially if they and others in
their family have relied on food for comfort in the past.
Some teens also have an identity crisis of sorts, having trouble
relating to others in their new, thinner body. Still others have
such high expectations - thinking that the surgery will boost their
popularity or bring them more attention - that they're
disappointed to find that old problems still exist even at a
smaller size.
To be sure, weight loss surgery is not a quick fix and is not
considered an "easy way out." There's a lot of hard
work involved. But for teens whose health is compromised by obesity
and who are willing to make the commitment to a new way of life,
the effort may well be worth it.
Reviewed by:
George A. Datto III, MD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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