While not much progress has been made in preventing childhood obesity, it is known that early is better – early as in pre-conception, if possible. It is more than clear that the younger a child starts being overweight, the longer that child will probably remain overweight, and the longer the overweight state lasts, the greater the chance that it it will ripen into adolescent obesity and solidify as adult obesity. “Early intervention” is the name of the winning game – which is fine, when discussing nutritious food rather than junk, the formation of sane eating habits, and the promotion of an active lifestyle.
When it comes to obese teens, however, early intervention has taken on a new meaning – namely, bariatric surgery. When Dr. Thomas Inge talks about his successes and those of others in his field, it is difficult to be unexcited about the “gratifying changes” he describes. As Childhood Obesity News mentioned last time, the Teen-LABS project has published a three-year followup study showing that teen bariatric surgery can stop diabetes in its tracks, alleviate hypertension, normalize body chemistry, save kidneys from destruction, and improve quality-of-life scores. What’s not to like?
Dr. Samer Mattar, MD, chief of the bariatric services program at Oregon Health & Science University, would very much like to receive more referrals from primary care physicians. He says,
We have 4.5 million severely obese children in the United States. When severe obesity affects people at such a young age, comorbidities latch on and set in so that by the time they are adults, they are experiencing the full ravages of chronic disease… We should be operating on more of these adolescents before they become severely compromised young adults.
Dr. Anita Courcoulas, who is chief of minimally invasive bariatric and general surgery for the University of Pittsburgh Medical Center, acknowledges that once an adolescent is 80 or 100 pounds overweight, diet and exercise won’t really do the trick. But she more conservatively recommends reserving bariatric surgery for the severely obese with co-morbidities.
As time goes on, the negative metabolic effects of obesity become more entrenched – so why not nip them in the bud? The main reason is because, apparently, they don’t stay nipped. Teenagers are notorious for being unwilling and unable to comply with a strict program in the long term. The benefits of weight loss show up, but then are lost over time as weight is regained. Of course, for these patients, the W8Loss2Go smartphone application could be a tremendous help. Dr. Pretlow advises pediatricians against using surgery as a bogeyman, quoting a girl of 13, carrying 254 pounds on a 5’6” frame, who said,
I am really scared about one thing my doctor told me … if i gain anymore weight I might have to have surgery … thats been giving me nightmares and stress … and as I said before stress makes me eat more …
If surgery itself is frightening, the things that can go wrong are even more so. YouTube.com hosts large array of short video presentations with titles like “Duodenal Switch Issues,” “Disordered Eating Post-Op,” and “Long-Term Post-Op Complications.” Surgery can lead to malnutrition. For example, reports about the Teen-LABS study noted that three years after gastric bypass or sleeve gastrectomy, about half the teenage patients were iron deficient, and some lacked in sufficient amounts of vitamins B12 and A. Of course nutrients can be supplemented, but monitoring is an ongoing responsibility. More serious was the need, in 13% of the patients, to have their gallbladders removed.
Pregnant obese women face extra problems, like increased risks for diabetes and hypertension, preeclampsia, and cesarean delivery. There is also more likelihood of excessive blood loss and wound infection, and anesthetic complications
In adolescent candidates for bariatric surgery, pregnancy will hopefully not be a factor. But just in case it is, the American Congress of Obstetricians and Gynecologists issued some guidelines:
Researchers have recently determined that complications of gestational diabetes, hypertension, macrosomia, and cesarean delivery are less likely in pregnancies after bariatric surgery than pregnancies of obese women who have not had the surgery. ..
Patients with adjustable gastric banding should be advised that they are at risk of becoming pregnant unexpectedly after weight loss following surgery…
All patients are advised to delay pregnancy for 12–18 months after surgery during the rapid weight-loss phase.
Your responses and feedback are welcome!
Source: “Teens Gain Big Benefits From Bariatric Surgery,” GeneralSurgeryNews,com, 12/07/15
Source: “Bariatric surgery in teens shows promise in study,” Triblive.com, 11/21/15
Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
Source: “Counseling and treating obese patients during pregnancy,” ACOG.org, September 2005
Image by Ian Bertram