Is Surgery the Best Answer for Very Obese Teens?

New research shows that the procedure is safe and could stave off big health problems later.

More than two million American children and teens have a BMI exceeding 40, which is considered severely obese. (Kin Images/Getty Images)

Feb 8, 2013· 3 MIN READ
Shari Roan is an award-winning health writer based in Southern California.

By the time Kelley Allen was just 17 she was exhausted from the effort of trying to lose weight. The New Concord, Ohio, teen had tried numerous diets. She measured her food to stick to smaller portion sizes. She played softball and was a cheerleader to burn calories.

Nothing helped.

"I started gaining weight in the third grade," says Allen, who is now 21. "But it became a problem for me when I got to middle school. Everyone changed. Kids were meaner. I was bullied."

Allen couldn't understand why she was unable to lose weight. "I was always active. I played sports all through school. But I noticed I was different from everyone else."

At 17, weighing 280 pounds, she asked her parents if she could have weight-loss surgery—also known as bariatric surgery—joining an estimated several hundred U.S. teens who have the surgery each year.

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Bariatric surgery in obese teens has gradually shifted from a controversial strategy to one that, today, is largely viewed as safe and effective.

Teens who qualify for the surgery must have a body mass index (BMI) greater than 40 (which means they’re at least 100 pounds over a healthy body weight), or a BMI greater than 35 along with obesity-related health problems such as diabetes or sleep apnea. Teens who want the surgery are also first evaluated to see if they’ll be able to adhere to the lifestyle changes, such as healthy eating and exercise, that are part of the surgery, and their psychological health. Many adolescent candidates for the procedure, like Allen, have spent years trying to lose weight with little or no success.

While there are fewer studies on the effects of bariatric surgery in teens, there is a wealth of evidence in adults showing that the procedure may be the most effective treatment for obesity-related conditions, such as diabetes, high cholesterol, and hypertension.

A study published in December in the journal JAMA Pediatrics found that most teens who have bariatric surgery undergo minimally invasive surgeries today, such as laparoscopic adjustable gastric banding, rather than open surgery. The study found that complication rates are low and that hospital stays for the procedure have become shorter.

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"There's a lot of very encouraging data that's currently out or is coming out," says Dr. Marc Michalsky, associate professor of clinical surgery and surgical director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, in Columbus, Ohio. The number of medical centers now offering bariatric surgery in teens, he says, "has really picked up over the last several years. It's widely offered now."

There is no question about the need for long-term solutions for obese youths. More than two million American children and teens have a BMI exceeding 40, which is considered severely obese. Four percent of children and teens have a BMI that is greater than the 99th percentile for age and gender. They often have type 2 diabetes, which was only seen in adults prior to the start of the country's obesity epidemic in the 1980s. Most obese teens will continue to have diabetes in adulthood.

While there are only short-term studies on the effects of weight-loss surgery in teens, many experts predict teens will benefit even more than adults by having the surgery earlier in life.

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"If you look at the real short-term outcomes, it looks like kids do the same, if not better, in terms of their weight loss," says Michalsky, an international authority who helped devise the guidelines for adolescent bariatric surgery.

Among adults, the average age for bariatric surgery is 40 or 50. "If you wait until you're 45, yes, you'll do well and lose weight and you may come off of your blood pressure medicine," he says. "But probably, as a result of three decades dealing with high blood pressure, there may be some damage to the cardiovascular system. We think one of the theoretical benefits of adolescent bariatric surgery is not only are you improving real-time quality of life, you are probably affecting [the risk of] long-term cumulative disease."

One new study from Nationwide Children's Hospital found the surgery helps reverse heart abnormalities in teens thought to be associated with severe obesity.

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Kelley Allen has no regrets about having surgery. Today, she is a college student majoring in communications and enjoying good health at 170 pounds. "After the surgery, the weight started to fall off," she says. "It was so weird going from struggling to lose weight to losing weight like crazy."

She has been able to maintain her 110-pound weight loss for two years now. "I followed all the instructions from day one: eating breakfast, keeping a workout regimen, eating healthy food," she says. She bristles when people criticize bariatric surgery in extremely obese teenagers but support cosmetic surgery, such as breast enhancement, for teens. "I think that people get scared that there is a lot of risk to this when, in reality, the surgery has about the same amount of risk as if you had your appendix removed," she says. "I'm really happy with how everything turned out."

Do you think very obese teens should consider weight-loss surgery?

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.