Some things about yourself are easy to change. Take your hair: You can grow it long or cut it short, and if you don't like it, a new look is just a quick snip or a few skipped haircuts away.
But some changes are not as simple. For the 1% to 2% of U.S. teens who are severely obese, losing those extra pounds can be one of them.
Being severely obese technically means someone has a body mass index (BMI) higher than 40, which roughly translates to being about 100 pounds overweight.
But the problem is more than just a number on a scale. Teens who are severely obese are at risk for serious medical complications like diabetes, heart disease, sleep apnea, and joint problems — sometimes right now and sometimes later in life.
For some people, sticking to a doctor-approved diet and exercise plan is enough to turn their health around. But for others, even major changes aren't enough. In these cases, where regular weight loss attempts have failed and a person faces medical problems from being overweight, weight loss surgery — also called bariatric surgery — may be an option.
What Is Bariatric Surgery?
Before we talk about what weight loss surgery is, we need to be clear about what it's not: It's not a quick fix, it's not for cosmetic purposes only, and it's certainly not for everyone.
Weight loss surgery works. But it's serious stuff — both physically and emotionally. In fact, having the operation is only one step in losing weight. It's the preparation for surgery and what comes afterward (like learning to adjust to a whole new way of eating and living) that can be overwhelming.
That's why most doctors only recommend surgery when they believe the person is willing and able to put in the lifelong effort it takes to make it a success. They want to be sure patients are prepared for the adjustments they'll have to make.
How Does It Work?
Weight loss surgery had its beginnings 40 years ago. Doctors noticed that people who had parts of their stomach or intestines removed to treat ulcers or cancer tended to lose a lot of weight after surgery — regardless of what they ate. They soon realized why: Not only did 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 bariatrics has come a long way since then, but weight loss surgery is still based on those same two principles:
- Restriction: This limits the amount someone can comfortably eat by reducing the size of the stomach.
- Diversion: By redirecting food around a portion of the small intestine, 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.
Weight Loss Surgeries for Teens
Today, there are two main surgical techniques for weight loss:
1. Gastric bypass surgery: In a gastric bypass, the surgeon creates a small pouch at the top of the stomach using surgical staples. This pouch becomes the "new" stomach. Surgeons then connect the pouch directly to the middle part of the small intestine (the jejunum).
After gastric bypass surgery, not only does the stomach pouch hold a lot less food — just 1 cup as opposed to the 8 cups or more that a normal-sized stomach can hold — the food also bypasses the larger part of the stomach and the upper part of the small intestine (duodenum). So the body both takes in less food and then absorbs fewer calories.
2. Gastric banding: Like gastric bypass, gastric banding surgery also reduces the size of the stomach by using a restrictive device (also called a LAP band) to create a small pouch. Unlike bypass, though, banding does not interfere with food absorption in the small intestine.
Both surgeries can be successful in teens.
Initial weight loss is greater with bypass surgery, although it is a more extensive procedure than banding. So patients may have more complications and need a longer recovery time. Gastric bypass surgery also tends to cause vitamin deficiencies because the revamped digestive system absorbs fewer nutrients. And, perhaps most important of all, gastric bypass surgery cannot be reversed — the patient will always have a smaller stomach and less intestine.
Gastric banding does not cause the same vitamin deficiencies as gastric bypass surgery. Plus the band is adjustable and removable, so if the procedure needs to be reversed, the stomach will return to its normal size over time. There are two downsides to banding, though: people might not lose as much weight as they would with gastric bypass, and the band may require replacement surgery at some later date.
Because gastric banding is a newer procedure, it is not widely used for people younger than 18, although clinical trials are currently underway.
Who Can Get Weight Loss Surgery?
Figuring out who's a candidate for weight loss surgery is a big decision that involves the patient, his or her family, doctors, nutritionists, and psychologists.
A teen candidate for bypass surgery generally has to have a BMI of more than 40 and be over the age of 14. But doctors consider a lot of other things as well:
- Is the patient healthy and mature enough for the surgery?
- Does the patient understand what's involved?
- Is the patient serious about making a commitment to a new lifestyle afterward — including nutrition, exercise, medications and vitamin supplements, and keeping all follow-up appointments?
- Are family members supportive and will they do their part to ensure the procedure is a success?
Because doctors tend to be cautious about weight loss surgery for teens, a patient should have several meetings with both medical and psychological experts who will decide if the person is a good candidate for weight loss surgery.
What Are the Risks and Side Effects?
Like any surgery, weight loss surgery comes with some risks. 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. In essence they have to relearn how to approach a meal: eating very small amounts, chewed thoroughly, and evenly spaced throughout the day. If they don't, not only will they continue to feel sick, but in time they can regain weight.
"Dumping syndrome" is another common problem that happens mainly with gastric bypass. This is when food moves too quickly through the stomach and intestines, causing nausea, weakness, sweating, abdominal cramping, and diarrhea. Because dumping can be made worse by eating high-sugar or high-fat foods, patients need be especially careful about the types of food they eat as their bodies get used to a different mode of digestion.
In addition, a very few people can have serious problems following weight loss surgery:
- reaction to anesthesia
- infection at the incision site
- a leaky stomach or intestine that can lead to peritonitis, an infection of the abdominal cavity
- a blood clot in the lung
- bowel obstruction
And last but certainly not least, there are the emotional side effects. It can be hard for some people to figure out a new, healthy relationship with food, especially if they've relied on food for comfort in the past.
Some people go through a bit of an identity crisis, having trouble relating to others in their new, thinner body. Still others have such high expectations — thinking that the surgery will bring them popularity or get them more dates — and are disappointed to find that problems still exist even when they are a smaller size.
Weight loss surgery is no magic pill. 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 could be well worth it.
Reviewed by: Mary L. Gavin, MD
Date reviewed: October 2013
Originally reviewed by: George A. Datto III, MD