Weighty Decisions Gastric Bypass Surgery Is A Growing Option For Morbidly Obese Children

Carnie Wilson had it done. So did Al Roker. And their triple-digit weight loss results made magazine covers.So it’s natural that, as gastric bypass surgery becomes more well known, its popularity will rise among adults. But what has been surprising to some health professionals is its growing use to treat teenagers.

According to a study published in the November issue of Pediatrics, gastric bypass surgery — the most common type of bariatric surgery, as it is technically known — is growing in prevalence, no doubt in part to the growing obesity trend among American young people.

Doctors admit that not everything is known about the long-term risks of the procedure, which shrinks the stomach to the size of an egg, and that the procedure’s risks are magnified in teenagers. But many doctors see no better option in a growing number of tough cases.

“I think there certainly is a subset of patients in the adolescent population that requires surgical management for their morbid obesity and should consider this as the main option for managing it,” said Dr. Imtiaz Munshi, a surgeon at Baystate Medical Center.

That’s the feeling of many doctors, and the celebrity success stories are sure to draw more interest from potential patients and their families. But bariatric surgery remains a difficult operation with a long-term impact on a young life. In short, it’s nothing to take lightly.

Hefty Trend

According to the American Society for Bariatric Surgery (ASBS), more than 100,000 people will undergo such procedures in a given year. Although no firm figures are available on how many are under age 18, doctors agree that the number is rising.

That’s partly a reflection of a childhood and adolescent obesity problem that doctors fear is becoming an epidemic in America. Using a body-mass index that compares height with weight, up to 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of young Americans might be obese, with 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} being severely overweight.

Many of the reasons are lifestyle-based, as a prevalence of fast food and junk food has combined with a culture of television, video games, and Internet use to help cultivate a generation of sedentary kids. Genetics obviously plays some role as well.

Increasingly, doctors and parents are seeking out solutions that might have seemed radical only a few years ago. Dr. Walter Pories, president of the ASBS, said an informal survey of 600 group members earlier this year revealed that about 10 had performed surgeries on children, all with positive results.

In one form of gastric bypass surgery, a small stomach pouch is created by stitching the stomach’s upper portion closed. The intestine is redirected to attach to the pouch and to bypass a portion of the small intestine that normally absorbs nutrients. The ensuing weight loss, often dramatic, is caused by a sharp reduction in both food intake and nutrient absorption.

The authors of the Pediatrics report, however, concede that there is no consensus as to what age and weight a young person should be before surgery, or whether the procedure itself, which can result in nutritional deficiencies in adults, might interfere with the development of bone mass, which is still peaking in the teenage years.

In some cases, the risks are simply worth it, Munshi said, stressing that Baystate recommends the procedure on occasion to teenagers but not to children.

“Right now, we don’t have a formalized plan or approach to handle youngsters, but we’ve made some inroads with teenagers,” he said, citing one example of a 14-year-old on whom his partner operated, who had weighed 500 pounds before the surgery.

Cover Stories

Two high-profile cases of gastric bypass surgery in adults have generated unprecedented interest in the procedure. Pop singer Carnie Wilson dropped from about 300 pounds to 148 after an Internet-broadcast surgery in 1999, at age 31. Then television weatherman Al Roker lost more than 100 pounds with a similar surgery.

Both of their stories were featured prominently in magazines and entertainment news programs, bringing the procedure to the attention of millions.

An increase in surgeries performed is obviously going to trickle down to younger patients, especially with adolescent obesity on the rise, Munshi said, but doctors need to exhaust other modes of treatment before opting for surgery, and Baystate is developing programs to help children deal with their obesity in other ways. But sometimes surgery is unavoidable, he said.

If surgery is chosen, pre-operative and post-operative processes are more complicated with children, and the risk factors are comparable to those of adults, including risks of malnutrition and gallstones.

But those risks are becoming more manageable, according to the ASBS, which reports that, in a study of 11,000 surgeries in the winter of 2000-01, 93{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} resulted in no complications at all, while major complications, such as hemorrhages and cardiac problems, were reported just 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time. Still, 30 deaths were reported among that group due to complications, or roughly one in every 360 procedures.

All that gives doctors pause, even if they do finally make the decision that gastric bypass is the way to go.

“We’ve done a select number of cases in the teenage population, but not in younger children at this time, though we’re planning to move in that direction,” Munshi said.
With no end in sight to the obesity problem in America, it seems that many doctors and parents are ready to move in the same direction.