Teens and Weight Loss Surgery

Dr. Owens, Medical Director at Coastal Center for Obesity, answers questions regarding teens and weight loss surgery.

Question: Is gastric bypass surgery safe for a teenager?

Dr. Owens response: The data in the medical literature shows that weight loss surgery is as safe in teenagers as it is in adults.

Question: When should teenagers consider gastric bypass as an option?

Dr. Owens response: Generally when they are in the top five percentile with regards to weight or roughly twice normal body weight. Less heavy teenagers with serious complications of obesity might be surgical candidates also. Although there is little evidence that significant weight loss can be achieved and maintained without surgery, teens considering surgery should have made at least one serious effort to lose weight without surgery. Also they should be willing to make a similar serious effort after surgery as surgery alone does not guarantee good long-term weight loss.

Question: What's a thumbnail description of the surgery?

Dr. Owens response: Gastric bypass is not the only effective operation to produce weight loss but it is the gold standard in the US. Laparoscopic adjustable banding has been done successfully on teenagers in Australia and is being adopted as a weight loss treatment in the United States. Unlike gastric bypass it does not alter the internal anatomy although it may be somewhat less effective in producing weight loss. Both procedures reduce the reservoir capacity of the stomach from about 2 qts to about ½ an oz, or 2 liters to 15 cc. In both procedures a small food-holding pouch is created from the very top portion of the stomach.

Question: Are teenagers more of a risk than adults, and if so, why?

Dr. Owens response: The concern with doing surgery on children and adolescents relates to interfering with normal development or setting the stage for long term side effects. Although the available information leaves some uncertainties, surgery for weight loss in severly obese teenagers is clearly preferable to no or inadequate weight loss. In addition to the dangerous medical effects of obesity, obese teenagers are stigmatized by their peers more severely than adults and suffer long term psychosocial effects. Hence, the longer term potential for undesirable side effects from surgery must be weighed against the emotional damages a teenager suffers from being severly obese.

Question: What are the risks - physically and emotionally?

Dr. Owens response: By and large the emotional risks of obesity are impaired self-esteem and depression. Suicide in teenagers is an important cause of death, although I am not aware whether it has been related to obesity or not.

Question: How can someone lose such a great amount of weight so quickly without changing their personality drastically?

Dr. Owens response: What we see in the first month after surgery is fair amount of ‘buyer’s remorse. After that patients are almost uniformly euphoric as they make progress in treating a disease they have suffered for years. A rare patient for whom food was their ‘only friend’ may become severely depressed. In approximately 2000 patients we have seen 3 or 4 suicides, perhaps half of which were related to the weight loss surgery. Many patients report difficulty thinking of themselves as thin even many months after successful surgery. Very few report significant difficulties adjusting to weight loss, although being rejected by still overweight friends is a common experience.

Question: How does the surgery alter a teenager's future?

Dr. Owens response: We believe that it reduces emotional suffering, improves socialization and improves the likelihood of a long healthy life.

Question: Can a teen still have children and go on to lead a normal adult life after this surgery?

Dr. Owens response: Yes. Losing weight improves fertility and decreases the likelihood of problems with labor and delivery.

Question: Do you have any statistics on how many teenagers are overweight, and how many have had gastric bypass surgery?

Dr. Owens response: More than half of teenagers are overweight and more than 25% meet criteria (greater than 95^th percentile) for obesity. The number who have had weight loss surgery is unknown but there are several publications in the medical literature supporting the safety and effectiveness of weight loss surgery in teenagers.

Question: Are the long-term effects of this surgery known? If so, what are they, and if not, why would you still recommend this as an option?

Dr. Owens response: All abdominal operations produce some long term risks but in general they are relatively minor or rare. There are a fairly large number of patients who are close to twenty years after gastric bypass and they seem not be having any particular problems. Iron, vitamin B12, and calcium deficiencies can occur after gastric bypass but are usually easily avoided with oral supplements.

Question: What is your response to critics who say that this option is an "easy way out" or that teenagers aren't mature enough to make this life-changing decision?

Dr. Owens response: Under the best of circumstances weight loss surgery is painful and moderately dangerous. To undertake surgery takes courage and a willingness to make changes and to be truly successful it takes a sustainedeffort afterwards. For the very obese there is no ‘easy way out’ and that there is any way out at all is to most of them very good news.