For Obese Teens, Surgery Is the Last Resort

Extreme obesity plagues more than 5 million teens and young adults, experts estimate. These youths tend to be at least 100 pounds or 100% above their ideal body weight.

Teens who have a body mass index (BMI) of 40 or greater are considered extremely obese. BMI is a way of calculating whether a teen or adult is overweight or obese. It is based on a measure of weight and height. A teen is overweight if his or her BMI is 25 to 29.9. Moderate obesity is 30 to 34.9, and severe obesity is 35 to 39.9.

The toll for that extra weight includes an increase in risk for heart disease because of high blood pressure and high cholesterol; obstructive sleep apnea, which can affect learning and quality of life; a high risk for type 2 diabetes; and a shortened lifespan. Psychological problems include poor self-esteem, depression, eating disorders, and social discrimination and isolation.

Reducing stomach size

What's a parent to do? More and more are looking at the same last resort as adults: adolescent bariatric surgery. Such surgery, in effect, reduces the stomach's size by about 95%. People who have this surgery generally feel full after eating 1 cup of food. Because less food can be eaten, the teen will need a vitamin and mineral supplement. The supplement should include B complex vitamins, vitamin E, iron, calcium and vitamin D. Calcium and vitamin D are especially important for bone strength.  

No one's sure how many surgeries have been done or are being done on children. Still, they're clearly on the rise. Studies of a small number of teens who have had adolescent bariatric surgery found that teens can lose up to 59% of their initial body weight.

Adolescent bariatric surgery isn't right for all obese teens. Doctors do not yet know the long-term outcome of adolescent bariatric surgery. In a recent Pediatrics article, Dr. Thomas Inge wrote that adolescent bariatric surgery is warranted in most cases only when adolescents:

• Have tried but failed at organized weight-loss attempts of 6 months or longer.

• Have a BMI of at least 40.

• Have finished most of their skeletal growth. That generally means girls must be at least 13 years old and boys 15.

• Have obesity side effects that weight loss would help fix.

In addition, adolescent bariatric surgery should be done only when the risk of surgery is the lowest. Risk increases as BMI increases. Teens who are in the super obese BMI category (BMI greater than 50) may have less successful surgery than teens whose BMI is lower.

Children must be willing to make a major change in their diet and make a significant effort in a supervised weight loss program for 6 months.

Parents and children must also understand the risk for complications, including the slight but real risk for death.

Post-surgery concerns

Long-term follow-up for adolescent bariatric surgery is a must. So is a strong commitment from you and your teen. There is a real risk of regaining weight. The surgery is only 1 step in a life-long weight loss program, which also includes dietary changes, vitamin and mineral supplementation, and exercise. A teen who has adolescent bariatric surgery should get nutritional counseling immediately after surgery. Because the teen will be eating less food, it's especially important that he or she follow a well-balanced diet.

Here are important suggestions for teens who have undergone adolescent bariatric surgery:

• At mealtime, lean protein should be eaten before other foods.

• Drink 8 to 12, 8-ounce glasses of fluids every day. These beverages should be sugar-free.

• Don't snack between meals.

• Get 30 to 60 minutes of exercise every day.

• Take a multivitamin every day.

The risk for gallstones and peptic ulcers increases for a teen who has adolescent bariatric surgery, and this risk continues through life. The doctor may prescribe medications to reduce the risk for these conditions. The teen may need to avoid certain other medications, such as aspirin and nonsteroidal anti-inflammatory drugs.