Weight Loss Surgery and Adolescents

Weight loss surgery in teens is a controversial topic.  Some experts feel that surgery is a drastic option for teen patients whose bodies may still be developing and who have not been given much time to lose weight on their own. On the other hand, some experts feel that the alternative to surgery is worse than the potential side effects; a lifetime of obesity, ostracism and diseases like diabetes.  Currently, according to a recent article in the New York Times, only 1-2 percent of all bariatric surgery procedures are on patients under 21, but there are on-going studies evaluating the outcomes of surgery on children as young as 12 and across the country, hospitals have opened weight loss centers for teens. Allergan, the maker of the popular adjustable gastric band, the Lap-Band, is currently seeking permission from the FDA to market Lap-Band to patients age 14 and older. (The current permissible age is 18.)

However, one of the biggest obstacles for teens that seek weight loss surgery is that their primary care providers will not make the referral. About half of pediatricians and family doctors, when polled, said that they would not refer an adolescent for weight loss surgery.  Dr. Thomas Inge, a professor of surgery and pediatrics at the University of Cincinnati, was quoted in the article, saying “many medical establishments provide the same advice over and over again to kids who are overweight — they just need to diet and play more outside. I wish it were that simple.”

While primary care providers may be hesitant to refer teenagers for surgery, the risks of bariatric surgery have, in fact, declined. An analysis of surgical records from 2009 indicated that 1 in 900 gastric bypass patients die during or immediately after surgery and the death rate for gastric banding patients is now 0.05 percent. This decline is in part due to the fact that surgeons are now more experienced and using less-invasive techniques—such as laparoscopy, which involves only 5-6 tiny incisions and uses devices with cameras–and also in part because thinner and healthier patients are now undergoing surgery. One of the concerns with performing weight loss surgery on teens is the potential for malnutrition following surgery. Malnutrition in teens could potentially affect bone growth, sexual maturation and other development.  It is more common in gastric bypass patients because their shortened digestive tracts absorb fewer nutrients. Because teenagers are often immature and uninterested in long-term consequences, one thing that all obesity experts can agree on is that if teens are to undergo surgery, it is essential that they have adequate education about the importance of adhering to their post-op eating program and making healthy choices.

Dr. Sunil Bhoyrul, an expert weight loss surgeon practicing in San Diego, responded to the publication in an article that he wrote in Translating Science. He said: “Even though I’m a bariatric surgeon, I’m eager to recommend alternative or supplementary approaches for caring for obese individuals — particularly adolescents. Young people who are obese are ideally suited for a personalized medicine approach that embraces recent advances in nutrigenomics and mobile health (mHealth).”  (mHealth refers to the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices such as smartphones, for health services and information.)

Dr. Bhoyrul concluded that “because adolescents already are highly engaged with mobile and digital technologies, I believe that they will be very receptive to using mHealth devices to track the calories that they burn during exercise and the calories that they consume by eating. These devices provide immediate, real-time feedback that helps empower individuals to take a proactive role in improving their health.”

A recent study showed that teens, even those actively trying to lose weight, are suffering from a significant lack of education about weight loss efforts. You can read more about that here.

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