AAP Guidelines — The Backlash Grows, Part 8

Body Mass Index measurement has been a bone of contention in many debates. More than 10 years ago, a study of nearly 15,000 young people led the British publication mirror.co.uk to print,

Health experts said yesterday that using Body Mass Index to calculate whether youngsters are obese is unreliable, especially for girls.

A 2013 article revealed this nugget:

Investigators […] analyzed data on people whose BMI and waist-to-height ratio were measured during the 1980s, looking at death rates a generation later… [T]hey found waist-to-height ratio was a better predictor of life expectancy.

In 2014, blogger Rodney Steadman wrote,

The BMI has become a big problem for some researchers… BMI does not accurately measure body fat in individuals with a high level of lean body mass (body weight minus the fat) and some ethnic groups. Furthermore, the BMI can be difficult to calculate in field settings when body weight cannot be accurately measured.

Meanwhile, parents who just did not like the whole idea argued with schools, and some questioned the ultimate usefulness of BMI information. As TorontoSun.com described in 2015, cultural factors were involved:

[…] BMI information alone may not be enough to help parents in high poverty areas where fresh produce and safe playgrounds to encourage exercise may not be available.

Around the same time, a study found that BMI measurement failed to identify “as many as 25% of children, age 4 to 18 years, who have excess body fat.” The Mayo Clinic’s director of preventive cardiology, Francisco Lopez-Jimenez, said, “BMI is not capturing everybody who needs to be labeled as obese.”

He also said, “That’s because it does have real limitations.”

Your responses and feedback are welcome!

Source: “What is Food Addiction?,” AnonymousOne.com
Source: “Hidden danger: UK’s childhood obesity could be worse than feared,” Mirror.co.uk, 06/18/12
Source: “Is BMI Outdated?,” MedicalDaily.com, 05/14/13
Source: “Absurd, but True?,” WordPress.com, 07/15/14
Source: “Screening teens for obesity may not help them lose weight,” TorontoSun.com, 07/03/15
Source: “Obesity Is Undercounted in Children, Study Finds,” WSJ, 06/23/14
Source: “Calling BS on BMI: How can we tell how fat we are?,” GantDaily.com, 08/16/17
Image by Todd Huffman/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 7

As Dr. Pretlow teaches, it is a lot better to treat the underlying cause of a problem than to treat the symptoms. One reason for this is, treating the symptoms is just not practical. Symptoms are rarely eliminated. They may hide, show up in disguise, or pull some other trick. But the smart money says, get rid of the basic reason for the problem. And that is a very strong incentive to back up and start at the source.

There is another quite convincing reason to work from the ground up. In the early stages, the preferred treatment for an eating disorder is on the behavioral level. Because all humans are fallible, mistakes may be made, but at least they don’t yet involve the routinization of drugs, or the amputation of body parts.

The best reason of all to take it slow is because these are minors. There is some legal stuff involved, to the point where healthcare professionals, administrators, institutions, and even parents might someday find themselves on the wrong side of a jury box. Some things cannot be done to an adult without fully informed consent. But parents can sign a form on their child’s behalf, and that is a mixed blessing that can be either a life-saver or a life-destroyer.

Upcoming professionals

Medical Students for Size Inclusivity is a grassroots advocacy group for which member Jessica Mui writes,

Weight loss surgeries take healthy, functioning organs and put them into a permanent disease state by reducing digestive hormone production, absorption of nutrients, and result in frequent complications. If we recommend these life-altering surgeries that come with a constellation of health risks for vulnerable youth as young as 13, we as medical providers are acting in direct opposition to our duty to “do no harm.” We cannot ask adolescents, who lack the ability to fully consent and manage their bodily autonomy, to risk their lives and well-being in an attempt to make their bodies smaller.

Some individuals fear a nightmare scenario where the authorities could capture a person and remove a big hunk of their stomach for that person’s own good — just as authorities can now capture and confine someone who is preparing to take their own life. In another, much more frequent example, a child who is bleeding out or drowning may be saved by anyone who is prepared to do it — even if neither parent is on the scene to sign a consent form. And certainly, the imperiled child is not offered a document and a pen.

Deep questions

Water inhalation and rapid exsanguination are life-threatening situations, where the response must be swift and decisive, so legal niceties can be put aside. Morbid obesity is a life-threatening condition, only on a longer timescale. Does that make it okay for adults, even parents or legal guardians, to step in and authorize the almost-total removal of a stomach? Some people say no, and many of those who theoretically approve would like to see more forethought exercised.

If a 13-year-old can consent to bariatric surgery, should they also be permitted to consent to other procedures, with or without parental consent?

Irreversible surgery on a minor child does seem to raise some ethical debate points, although it happens every day in the case of, for instance, routine neonatal circumcision. And if a child is born with a cleft lip or palate, parental permission is enough.

Dr. Danielle P. Burton writes of bariatric surgery,

Can a thirteen-year-old truly consent to the lifelong undernourishment caused by such a radical procedure? Can they consent to the increased risk of suicide? While it is great to minimize the risk of potential future disease, it cannot be at the cost of premature death. A key factor in helping our children grow into healthy adults is making sure they live long enough to become one.

Your responses and feedback are welcome!

Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by NIH Image Gallery/Public Domain

AAP Guidelines — The Backlash Grows, Part 6

Dr. Pretlow is by no means alone in preferring prevention over cure. Just as a random example, see Dr. Daisy & Co, where the file title “Resource Page for Harmful AAP Guidelines” kind of gives it away.

While not claiming to hold the only answer, the dietitians there treat not “obesity,” but eating problems. They remind us that “Safe, successful and evidenced-based nutrition interventions exist for pediatric eating concerns.” They reject aggressive treatment, restrictive diets, appetite suppression meds (beyond a certain point), or stomach surgery. Like so many others, they point to the lack of long-term research. And they call the American Academy of Pediatrics guidelines “a step backwards.”

Two key words: forethought and evaluation

Psychiatrist Kimberly Dennis, who specializes in treating addictions, eating disorders, and co-occurring disorders, says:

As for referring certain kids 13 years or older for bariatric surgery, my main concern is that there is little data on the long-term physical and mental health effects of this drastic and expensive procedure when performed on young people.

A Swedish study followed up 81 severely obese teens for five post-op years and:

[…] 20 test subjects (25 percent) ended up requiring follow-up surgery because of complications from the original procedure, and 58 subjects (72 percent) showed some type of nutritional deficiency at the five-year follow-up. No mental health screens were listed as having been done.

That last part, about the absence of mental health screening, disturbs not only Dr. Dennis, but Dr. Pretlow and plenty of others. Let’s hear from Dr. Mélanie Henderson, a pediatric endocrinologist and researcher in Canada (which is also developing new obesity treatment guidelines). In that country, at present, a teen may be considered eligible for weight-loss surgery after two years of behavioral intervention.

Dr. Henderson cites the “alarming” rise in obesity that “has led to a greater need for surgery for teens whose mental and physical suffering typically worsens into adulthood.” According to this point of view, there should be more emphasis on not only mental health but on other quality-of-life issues and interventions about which, incidentally, “We don’t have a lot of data.” The report continues,

[A] review of studies over the last decade suggests evaluations of anxiety and depression, for example, are lacking even though those issues are addressed in various intervention programs… Obese children are at three times the risk of depression compared with their non-obese peers due to the stigma and shame…

Medical writer Virginia Sole-Smith makes a strong argument for improvement at the forethought stage, rather than just measuring a child’s BMI and jumping to the conclusion that surgery must be scheduled. She writes,

The step that a lot of people are skipping is the evaluation component… The guidelines talk about an extensive physical laboratory evaluation, evaluation for eating disorders, evaluation for mental health problems. And based upon that evaluation, then we have an individualized treatment plan for that individual.

Nooshin Kiankhooy is an eating disorder specialist and founder of a therapy practice, who spoke with the popular program All Things Considered about clinicians who make evaluations under the current rules:

[W]hat I understand is these evaluations are very short, maybe an hour long, and they’re kind of put on a timeline by the physician or even by the insurance company, right? And that is not at all an amount of time, I think, that can allow for a proper evaluation.

Your responses and feedback are welcome!

Source: “New AAP Guidelines for Childhood and Adolescent treatment of ‘obesity’ Resource Page,” DrDaisy.com, undated
Source: “A Critical Look at New Guidelines for Kids With Higher BMIs,” PsychologyToday.com, 02/11/23
Source: “Ahead of new childhood obesity guidelines, doctors say surgery is an important option,” CoastReporter.net, 02/17/23
Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “This eating disorder expert is worried by new guidelines to treat childhood obesity,” WVIA.org, 02/17/23
Image by michellereyntjens/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 5

Yesterday we mentioned Dr. Danielle P. Burton, who has more to say about the recently revised guidelines of the American Academy of Pediatrics. The document grants only “sparse discussion” to eating disorders, and Dr. Burton continues:

[The guidelines] do not mention the medical complications of eating disorders, which are numerous and far exceed the medical complications of obesity… Eating disorders represent a lethality that far outweighs that of obesity, and at a much younger age.

Does this sound crazy? Perhaps, but she cites research showing that people with anorexia are 18 times more likely to die by suicide, and those with bulimia are seven times more likely to die by suicide than other individuals of the same age and gender.

And, she says, the guidelines “fail to mention that the risk factors for developing an eating disorder are closely related to those for developing obesity.” Which in both cases seems to advance the argument for doing something more than just treating the symptoms. Whether a patient is obese or has an eating disorder or both, it’s all part of the same problem that does not appear to be handled very effectively at present.

The knife

In the field of juvenile bariatric surgery, it seems that the potential for iatrogenic or healer-caused harm is very present. Online forums supply plenty of examples, and complete articles from experienced patients sometimes appear, like the eloquently titled “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” published by Slate.com. Headlines are sometimes awkward, and it is likely that the young woman’s other problems were also real. What we seem to be talking about here are basic, first-cause situations.

The author’s story

Amy Scheiner was diagnosed as obese at age eight, and by 16 was pre-diabetic. At 17, she underwent bariatric laparoscopic banding, or lap-band surgery. It was not a magic bullet. She writes,

[B]y the time I was 23, I had begun having side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease… It was then I realized that the surgery that was supposed to cure my obesity problem had done a poor job of addressing the underlying issue, which comprised a tangle of mental health and environmental challenges.

Amongst all the doctors and diet experts the author met with, none had ever asked “what was wrong in my family, in my mind, or in the culture… My weight was a symptom of the dysfunction around me.” Consequently, she started therapy, but then bounced from binge-eating disorder to hyper-vigilance, excessive exercising, extreme calorie restriction, and purging. This went on until she was dangerously dehydrated and vomiting blood, and still in semi-denial. “I knew I was sick, but at least I was thin.”

As an adult, Scheiner describes how her entire young life was defined by her physical size, leading to an unhealthy obsession with weight. Although the doctors promised her that having surgery at 17 would make her happier, it did not — but only left her with “more problems to untangle as an adult.” She goes on to say,

I worry for the children who will have permanent bariatric surgeries before they really understand their relationship with food, and self-worth.

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” Psychology Today, 03/04/23
Source: “I Had Weight-Loss Surgery at 17, and It Worked—but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Image by Wonder woman073/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 4

Last time, this page explored more deeply the concept of iatrogenesis as it relates to the newest American Academy of Pediatrics guidelines. Not surprisingly, in the realm of long-lasting trauma, there is more to say. A lot of it is said by a pediatrician and psychiatrist Dr. Danielle P. Burton, who is herself in recovery from an eating disorder:

Including weight loss pharmacology and bariatric surgery in the AAP obesity guidelines is premature, irresponsible, and dangerous. The dangers of these guidelines increasing suicidality and perpetuating eating disorders are much greater than the risks associated with being overweight or obese.

Dr. Burton is not happy with the AAP’s “sparse discussion of eating disorders” and goes on to say that among teens, suicide is one of the three leading causes of death, the others being accident and homicide. She wrote:

The potential of these guidelines to increase suicide risk is multifactorial. The first is a direct cause: One study, published in January of this year, found that bariatric surgery increases the risk of suicide, especially in the youngest patients.

The second cause is indirect. By promoting fatphobia, these guidelines are likely to increase the risk of adolescents developing eating disorders.

Jessica Mui reports that the organization Medical Students for Size Inclusivity has requested that the AAP rescind the guidelines and re-examine its premises. This grassroots advocacy group of medical students is also worried about potential harm because “children will learn that their bodies are a pathology rather than a variation on the normal spectrum of body shapes and sizes.” The concern here is that kids will regard normal weight gain as a personal failure, which may irrevocably harm their sense of self-worth.

And yet, it would be enormously better to concentrate on eating disorders and do everything possible to cure them early, than to decree, “This this person is obese, let’s bring out the pills or the scalpel.”

Would it not be more beneficial to get the person un-obese in some way that doesn’t pile on additional trauma? Wouldn’t it be preferable to help him or her to unlearn the false coping skills that created obesity in the first place? And incidentally, how can we find in this person’s experience a way to help little kids not ever have to go there?

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Simone Lovati/CC BY-SA 2.0

AAP Guidelines — The Backlash Grows, Part 3

Since the beginning of the year, when the American Academy of Pediatrics issued new advice, emotions have been stirred up, and Childhood Obesity News has been looking at some of the repercussions. Many of the interested parties refer to the guidelines as “aggressive.” Some mean it as a compliment; others, not so much. Personalities who see everything as a battle say that the chronic illness of obesity must be treated like an enemy, with aggressive intervention. This can be mistaken for an attack on obese people.

The culture on the whole seems to prefer to let problems fester, and then attack them vigorously. It is surprising that we have not yet been asked to enlist in a full-scale War on Obesity. (Oops, it seems that we were, back in 2006. But that is a topic for another day.)

Conversely, many practitioners and influencers believe in loving attentiveness, followed if necessary by an intervention that is timely, gentle, and persistent.

Emotionally loaded

We have touched on the concept of insensitivity, along with the shocking lack of training that leaves some medical professionals saying too much, saying the wrong things, or not saying anything at all, when a different response would be more appropriate and useful. We have also explored what happens when the concept of iatrogenic, or healer-caused harm, enters the picture.

Virginia Sole-Smith has a new book coming out, titled Fat Talk: Parenting in the Age of Diet Culture. In a recent New York Times op-ed she wrote,

[W]e cannot solve anti-fat bias by making fat kids thin. Our current approach only teaches them that trusted adults believe the bullies are right, that a fat body is just a problem to solve.

In other words, this is supposed to be about reducing bias and stigma. Sole-Smith points out that we don’t blame kids for having asthma or other chronic conditions, and that blaming them for their weight is counterproductive, to say the least.

Practitioners and parents feel outrage, or something close to it, when contemplating the possible dangers to children, including “irreparable harm.” An uncredited author described two major criticisms of the guidelines:

1. They do not mention or caution pediatricians around eating disorders and disordered eating
2. Focusing on weight does not lead to health. It leads to shame and unhealthy behaviors

Many kids are highly likely to feel shame or self-doubt when they sense an adult is judging or criticizing their weight or food relationship, especially someone in a professional capacity. It is staggering the number of individuals I encounter who… can link the beginning of their disordered eating behaviors to a conversation with a doctor who negatively talked about their weight.

Your responses and feedback are welcome!

Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Image by Scott Maxwell/CC BY-SA 2.0

AAP Guidelines — the Backlash Grows, Part 2

This post is a continuation of yesterday’s, whose general topic is the increasing unrest over the latest guidelines published by the American Academy of Pediatrics. In particular, we are now discussing the various sorts of damage that healthcare professionals can unwittingly or carelessly bring about.

Iatrogenic harm can be produced not just by bacteria or a scalpel, but by words, and even without words. Yes, the spoken and unspoken communications of a physician, nurse, or other staff members can also cause significant damage. One website for medical professionals says,

Less well recognized are the potentially harmful influences of the knowledge, values, beliefs, and attitudes of well-intentioned health care providers and patients themselves, upon patient outcomes.

Another source quotes these thoughts from Arthur J. Barsky, M.D.:

Some of the information that physicians convey to their patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress… One mediator of this variability between symptoms and disease is the patient’s thoughts, beliefs, and ideas… Although cognitions may not cause symptoms, they can amplify, perpetuate, and exacerbate them, making symptoms more salient, noxious, intrusive, and bothersome.

In the worst cases, this is the stuff of malpractice lawsuits. The Journal of Ethics explains a fine distinction:

Iatrogenesis refers to harm experienced by patients resulting from medical care, whereas negligence is more narrowly conceived as deviation from standard care. While all harm resulting from negligence is iatrogenic, not all iatrogenic injury is negligent.

Now, speaking of symptoms and disease, one problem pointed out by Dr. Pretlow and many others is the tendency of some clinicians to skip too speedily over the history and variety of symptoms. They head straight for the preconceived and possibly erroneous “answers,” which in perhaps too many cases tend to be either drugs or surgery. A sort of mass amnesia takes over and causes many healthcare professionals to forget that something came first, before symptoms.

In common parlance, we call that thing a cause. As Dr. Pretlow says,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

When a ship begins to sink, the water that sloshes around the sailors’ ankles is the indicator that something is wrong — the symptom. Naturally, some of the crew grab buckets and start bailing, and of course, others get to work on fixing the sails. But isn’t it a good idea to first locate the holes through which the water pours in, and plug them? When the underlying cause of the patient’s obesity remains unaddressed, how much good can be accomplished by a weight-loss drug regimen, or even bariatric surgery?

Sadly, failure to ponder the symptoms, along with the proclivity to leap to a demanding and costly solution, could in some cases be fairly characterized as iatrogenic harm. And nobody wants that.

Your responses and feedback are welcome!

Source: “Iatrogenesis,” HIGN.org, undated
Source: “The Iatrogenic Potential of the Physician’s Words,” JAMANetwork.com, 12/26/17
Source: “When Is Iatrogenic Harm Negligent?,” AMA-assn.org, August 2022
Image by driver Photographer/CC BY-SA 2.0

AAP Guidelines — the Backlash Grows, Part 1

Rather than settling down, it appears that resistance against the guidelines recently issued by the American Academy of Pediatrics grows more vehement as time passes.

Of course, some individuals and groups had plenty to say before January even ended. The Academy for Eating Disorders (AED) warmed up by calling the document a “major shift in perspective,” although diligent readers of past AAP publications believe it was easy to see this coming. Their statement ended by asking the AAP to revise this last edition of the clinical practice guidelines for obesity, and to include input from “key stakeholders” such as eating disorder professionals and actual patients who have lived through these problems and processes.

The AED has three main objections, and one of them is that the Guideline does not have much to say about screening or treatment referral for people afflicted by eating disorders. There is “no clear course of action for healthcare providers to take if an eating disorder is suspected or identified.” This is especially important because it is exactly the type of problem that needs to spotted and derailed early on.

Sensitivity

Another concern is that it does no good to recommend that clinicians approach the topic of weight in a sensitive manner, when they are offered no training on how to do that. Furthermore, there is a lack of long-term data on pharmacological and surgical interventions among the pediatric population. Rather than concentrating on individual-level changes like drugs and surgery, the group would much prefer to see more emphasis on structural reconstruction, like changes in food policy, the reduction of food insecurity in the population, and the reduction of stigmatizing attitudes in people’s minds.

Also criticized the lack of information on how “eating disorders can and do emerge after weight-loss surgery.” Another objection is, to put it delicately, “we wonder about the independence of the AAP recommendations given the financial reliance on pharmaceutical companies that is often required to investigate medication efficacy.”

The AED quotes the Hippocratic Oath, especially the part about “First, do no harm.” And mention of the oath leads into another ancient concept, iatrogenesis, derived from the Greek words for healer and causation. The AED feels that all the explicit focus on weight loss, in the ideas and practices being advocated, carries the potential for iatrogenic effects on some patients.

In the medical universe, that is a very scary word, partly because it has shades of meaning. In the most benign sense, it refers to problems that are not considered to be in the natural course of an injury or illness; harm that results from diagnostic procedures or medical treatment but without any intention. Charging a doctor with causing an infection would be a whole different level of an accusation than charging a hospital ward with causing one.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Academy for Eating Disorders Releases a Statement,” Newswise.com, 01/26/23
Image by Johan Lange/CC BY 2.0

What They Say About Bariatric Surgery for Kids — Part 2

A lot of news stories elicit massive commentary when first published, but only some of them sustain interest for very long. In the past weeks, Childhood Obesity News has explored many angles of the American Academy of Pediatrics opus, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.”

We looked at a piece called “Children with obesity should get proactive treatment, including medication, surgery: new guidelines.” The word choice in that headline is indicative of how the reactions fall into categories. Some ask for treatments that are not just proactive, but aggressive. Others go further and insist on treatments that work. This might lead to a discussion based on the question, “Define work?”

If a weight-loss method involves expensive and potentially harmful endless dependency on pharmaceuticals, can it fairly be said to work? Can an intervention be honestly defined as effective, if it involves the removal of a major organ? Does it really work if it requires a lifetime of walking a nutritional tightrope? Can a person take in enough essential vitamins to compensate for the missing body parts, and at the same time not eat enough food to stretch the remaining stomach and invalidate the surgery?

Putting the cart before the horse

That good old saying is about doing things backward. Let’s be real. Tennis elbow could be eliminated by amputating the entire arm. Certain behaviors can be stopped by slicing out part of a person’s brain. Weight can be lost by taking a drug that may considerably increase the underpants laundry bill.

But just because a thing can be done, does not mean it should be done. And, important as these questions are, there is something even more basic going on. As Dr. Pretlow expresses it,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

Exactly. This fairly obvious fact has been noticed by laypersons and healthcare professionals alike, both immediately and in the ongoing second wave of responses. If more attention were paid to the underlying causes, we would not have to worry about the potential for various ugly complications like the ones listed by Christine Byrne in her article for Self.com, including…

[…] gastroesophageal reflux disease, chronic nausea and vomiting, the inability to eat certain foods, weight gain or failure to lose weight, low blood sugar, malnutrition, ulcers, bowel obstruction, and hernias.

And when certain statistics are aired, concern rises:

The guidelines also state that between 13 and 25% of those who get bariatric surgery will need a follow-up procedure within five years.

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment, including medication, surgery: new guidelines,” 6abc.com, 01/10/23
Source: “The New Obesity Guidelines for Kids Are Appalling,” Self.com, 02/02/23
Image by Stephen Edmonds/CC BY-SA 2.0

What They Say About Bariatric Surgery for Kids — Part 1

Recently, we followed early reactions to January’s American Academy of Pediatrics guidelines, then offered a retrospective look at what had been said here about the topic, previous to those new guidelines, with a comprehensive catalog of various aspects and angles (the pages known as Bariatric Surgery Roundups, #1 through #6). This has obviously been a hot topic for a long time.

Here is a look at some additional pieces that have appeared in the press in the recent past. The older gastric band method, in vogue until around 2008, was less invasive and less permanent than some other styles of weight-loss surgery, but had high complication and failure rates. As patient Amy Scheiner described,

A reversible, inflatable device was placed around the top portion of my stomach, creating a smaller “pouch” and limiting the amount of food I could consume.

By way of contrast, the current favored option, the gastric sleeve or sleeve gastrectomy, is done laparoscopically, with generally five small incisions. About 80% of the stomach is removed. The hospital stay is short (a day or two), and the overall recovery time is not long.

On the other hand, the lasting metabolic changes might not all be positive. The big problem is, it’s not like having a broken arm casted until it mends, and then the child goes on their merry way, good as new. The surgical option requires genuine long-term (as in, life-long) commitment and inflexible adherence to strict nutritional requirements. As Gina Kolata noted in The New York Times,

You have it the rest of your life. You cannot reverse it. You can’t say, I want my old intestines back. It’s gone.

Specialist Monika Ostroff is the executive director of the Multi-Service Eating Disorders Association. She has worked with many patients who developed eating disorders after bariatric surgery, some of whom were operated on as teenagers. Ostroff says that the surgery completely changes the way in which a person can nourish their physical body, from food amounts and types to their method of chewing. If patients are not adequately prepared for these radical changes, disaster can ensue.

The “forever” aspect is a very big deal to some people. Dr. Katy Miller (a hospital medical director in charge of adolescent medicine) was quoted:

[I]t is a very serious surgery that carries profound impacts for the rest of a patient’s life.

Your responses and feedback are welcome!

Source: “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Source: “An Aggressive New Approach to Childhood Obesity,” NYTimes.com, 01/26/23
Source: “New childhood obesity guidance raises worries over the risk of eating disorders,” NPR.org, 02/15/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Image by faungg’s photos/CC BY-ND 2.0