Should obese teens have bariatric surgery?

The HealthGal Health Guide
  • Weight loss surgeries now amount to $6 billion a year, accounting for about 220,000 surgeries and aftercare. One to two percent of these procedures are performed on patients under age 21. Allergan, the makers of the lap band are now seeking FDA approval to market the procedure to patients as young as 14. Currently age 16 is the cut off. Studies have confirmed that even with modest associated weight loss, the surgery may thwart diabetes. Another recent study suggested that it also can thwart heart disease and stroke risk. Given those positives and the obvious knowledge that once excess weight entrenches itself, it can be quite daunting to lose the excess weight and then keep it off long term, why not consider bariatric surgery as a tool to treat teen obesity?

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    Well, some experts feel that it is quite extreme to change the anatomy of a person before they have completed full physical (and emotional) development. These teens are usually not at risk of immediate death so why turn to this procedure that has its own short term and long term risks? On the other hand, if you look at "dieting success," it has a rather dismal long term statistic in terms of keeping substantial weight off for a significant amount of time. So a procedure that might allow you to achieve goal weight for the long haul might be a valuable weight management option. And in the case of the lap band, you can reverse the procedure, should a female patient want to become pregnant. Of course, a better outcome is ensured if psychological counseling occurs prior to surgery.  It helps to weed out poor candidates and also offers the patient tools like behavior modification prior to the actual surgery itself.  counseling and support should continue for many months, if not years, post surgery as well.

     

    If you consider a cost of about $22,000 for adjustable gastric banding versus the costs of a lifetime of unsuccessful dieting and the health complications associated with excess weight, it sounds like a good deal - especially if insurance covers it. Since the surgery can be done laparoscopically, some risks are lowered. Open bypass surgeries do have a complication death rate of 2% in the first 30 days. Patients who have the lap band (even as a closed laparoscope procedure) still risk blood clots or bowel perforation. And a new Belgian study seems to suggest that closed lap band procedures may not be a panacea. Nearly half of adult patients who had the lap band asked that it be removed within a 12 year period due to a variety of issues including:
    Not as much weight loss as hoped for

    • Regained weight despite lap band
    • Heart burn
    • Vomiting
    • Stomach perforation due to slippage

    A separate German study also found that 30% of patients wanted the band removed within 14 years because of slippage complications. And an Australian study found that about a third of teens who had lap band placement needed surgical intervention because of a phenomenon called "pouch dilation," which means a portion of the stomach above the band enlarged, allowing more food to be consumed and interfering with optimal results. This final complication speaks volumes to the need for counseling and ongoing support to help patients continue to follow post operative recommendations regarding nutrition (and exercise), to allow for optimal weight loss and weight maintenance.

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    Another consideration is the idea that some patients can experience malnutrition after this kind of surgery. Once you have bariatric surgery of any kind, you do need to supplement daily to make up for certain vitamins and minerals that do not get absorbed because of the rapid transit time of food. You also need to eat tiny meals which may have you avoiding certain food choices or simply not eating enough of certain foods. So you do need to weigh the surgical risks and the long term new habits you have to adopt versus the lifelong battle to lose weight, keep it off, lose (more of) it again, try to keep it off again. Problem is, many patients will find ways to outsmart the smaller stomach, which may require tightening the band and re-working how much, when, and what you eat. It's not a magical solution to weight loss - you still have to "work the program."

     

    Make sure if you do consider surgery, you check out the surgeon and confirm that he is board certified and that he specializes in this surgery and has significant experience. Set up a support team and begin changing your habits before the day of surgery. Remember that if you do hit goal weight, you still have "the disease called obesity." It is merely in remission. So keep your support team in place for months, even ears post surgery. That may help you to maintain those habits you fought so hard to adopt. Remember that whether you choose diet, surgery or both - take it one day at a time.

     

    One additional note: A new study just released suggests that bariatric surgery offers faster weight loss with fewer complications, when compared to band surgery.

Published On: January 17, 2012