Obese teenagers seen as candidates for gastric bypass

By Nanci Hellmich
USA Today

As gastric bypass surgery becomes increasingly popular to treat morbidly obese adults, some doctors are endorsing the operation for very overweight teenagers.

A study presented last month suggests the surgery helps slim down teens who are 100 or more pounds overweight. Supporters say it's a viable option for some whose weight may threaten their lives eventually. But others believe it is risky, and no one knows the long-term side effects.

Alan Wittgrove, medical director of the bariatric program at Alvarado Hospital Medical Center in San Diego, tracked 37 teens ages 14 to 18 who had laparoscopic gastric bypass. He found they had lost an average of 82 percent of excess body weight a year after surgery. He is discussing his work Friday at the annual meeting of the American Society of Bariatric Surgery in Boston.

More than 100,000 morbidly obese people will have weight-loss surgeries this year, according to the society. There is no data on the number performed on teens.

Heavy adolescents often have health problems such as diabetes, high cholesterol and sleep apnea, and many suffer from low self-esteem.

"Morbid obesity is a life-threatening disease," Wittgrove said. "The majority of these kids aren't healthy. They can't walk a block. We have to offer these kids some alternative, and we have an effective alternative now."

A group of national pediatric obesity experts met recently to establish guidelines for the surgeries for teens. Among the conclusions:

• Adolescents should have reached nearly their full height and sexual maturity before having the surgery, because of concerns about how it might affect their growth and development. "We take issue with operating on 10-, 11- and 12-year-olds," said Victor Garcia, who was part of the group and is co-director of the Comprehensive Weight Management Center at Cincinnati Children's Hospital Medical Center.
• Only the extremely overweight should consider the operation, because "we don't know the long-term effects," he said.
• Teen candidates need to have a family environment supportive for weight loss. "You don't want to put them through the operation, and then a few years later have them gain all the weight back," Garcia said.

All other weight-loss methods need to be tried first, said William Dietz, director of the division of nutrition and physical activity for the Centers for Disease Control and Prevention.

Some experts say the surgery on kids needs more investigation. "We don't know its repercussions long term — is it helpful, how does it work, what are the potential side effects?" said Robert Berkowitz, associate professor of psychiatry and pediatrics at the University of Pennsylvania.

The risks — considered very slight — include wound infection or leakage at the opening between the stomach pouch and the intestine, and even death, Wittgrove said.

The surgery costs an average of $26,000. Insurance has covered operations on adolescents.