Another Teen Surgery Compendium

Last week, we were just getting started on a reminder post about all the aspects of bariatric surgery for young people that have been discussed here. Supposedly, without it, only 2% of severely obese teens can achieve long-term weight loss.

As Dr. Pretlow says, bariatric surgery is the only obesity treatment that has resulted in significant long-term weight loss. But that alone is not much of an endorsement, because its record is not unblemished. There seems to be an overall 20%-30% failure rate attached to teen weight-loss surgery.

One of the problems in assessing this is the lack of long-term studies, because allowing young people to be operated on in this way is a relatively recent phenomenon. There are pros and cons galore.

Even the safest procedure, the Lap-Band method, has its risks. Even in the very best-case scenario, the person who has most of her or his stomach blocked will need to rigorously adhere to a whole new set of lifestyle rules. A common drawback with any of the various procedures is that often, the underlying emotional deficiencies are not addressed. The patient is just as insecure, troubled, and bereft of coping skills as before — with the added burden of a post-op routine that never ends.

It is an accepted fact that severely obese teens resist lifestyle changes and medication, and the bad news is that every type of weight-loss surgery brings inevitable lifestyle changes and probably some involvement with medication, even if it is only nutritional supplementation. Teenagers can be willful and heedless, and if a young person ruins a Lap-Band placement by eating so much that the small remaining pouch enlarges, the question “Where do we go from here?” is serious and possibly life-threatening.

This excerpt from a post about risks and complications paints a dismal picture:

The conditions that might indicate the need for a revisional procedure include the inability to tolerate solid food; nausea and vomiting,; strictures; nonhealing ulcers; and severe dumping syndrome. The revisional procedures come under the headings of conversion, correction, or reversal. With them, the mortality goes up to 1.65%. The need for a reversal is counted as a treatment failure. In addition, some of these surgical interventions are designed from the start to occur in stages, which guarantees the need for additional surgery.

A 2010 survey of doctors found that nearly half of them said they would never refer a teen patient for any type of bariatric surgery. Deeply-felt ideological battles have been fought in this arena. One centers around the concept of early intervention, which is always felt to be superior — unless that intervention is surgical.

Babies need intervention before they are even conceived, and that’s undeniably early. Mothers are given a ton of advice on how not to produce an obese child. But when it comes to operating, the teen years strike many professionals as being too early to intervene in that particular way. “More about Bariatric Surgery for Adolescents” looks back at some of the early efforts to make use of the technology without doing harm.

We discussed Teen-LABS, or the Teen-Longitudinal Assessment of Bariatric Surgery, whose goal is “to facilitate coordinated clinical, epidemiological and behavioral research.” It has become accepted that increasing numbers of these procedures will be done, so the task now is to figure out the best ways to keep everybody healthy.

Fortunately, Teen-LABS is interested in understanding the causes and the behavioral ramifications of adolescent obesity — those underlying emotional issues that so often get in the way of true and lasting recovery. The same post also outlined a case history.

As always, Childhood Obesity News recommends the W8Loss2Go smartphone application as an adjunct to, or even a substitute for, surgery.

Your responses and feedback are welcome!

Image by Ian Bertram.

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Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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