What are the Risks of Obesity Surgery for Teens?

We're seeing two new trends today. The first one became noticeable a couple of years ago: kids are getting fatter. No one has a clear idea of why; some blame it on video games and televisions, others on fatty food habits picked up in school lunchrooms and home, and still others on a relatively indulgent and often absent parenting style.

The second trend is obesity surgery for teens. With the drastic rise in teen obesity, it's easy to see why this has become a trend.

Which Teens Get Obesity Surgery?

According to published guidelines in the magazine Pediatrics, teens who want obesity surgery should:

* Have failed at least a six-month organized weight management program (or series of them) under the care of their pediatrician or family doctor.

* Be fully physically mature, or nearly mature.

* Be severely obese with a minimum body mass index of 40 and obesity related disease - or have a BMI of 50 or more with or without disease.

* Have medical and psychological evaluations both pre and post procedure, and show no signs of addictive behaviors or binge eating behaviors; approach to food should be normal and healthy.

* Promise not to get pregnant for at least a year post-surgery.

* Be motivated and able to follow the specified diet post-procedure.

* Be mature enough to make decisions, and capable of providing an informed consent to surgery.

* Have a supportive family that is motivated to help the teen follow a diet and exercise plan post-procedure.

The Quick-Fix Society

So why the sudden turn to surgery rather than the tried-and-true methods of diet and exercise? We live in a quick-fix society, and it's getting worse. Teens today have less patience than I had at that age, only twenty years ago. If diets don't help them drop five pounds right away, they switch to another. Physical exercise is taxing to the body, and many aren't fit enough to start any kind of exercise program without some weight loss first.

A pill can fix some things. But obesity is only quickly treatable with pills that also harm the body, or with surgery that alters the size and shape of the stomach.

Side Effects of Obesity Surgery

The death rate due to complications from obesity surgery is low, about one percent; complications ranging from stomach leakage to infection are at about ten percent. Teens who have bariatric surgery are less likely to die or suffer from side effects, probably because they are young and have not had time to develop diseases like high blood pressure or diabetes.

However, over the long run obesity surgery may lead to malnourishment. This doesn't mean the patient starves. Rather, the ability of the digestive tract to absorb essential nutrients is lessened. This means that a variety of complications related to vitamin or mineral deficiency can arise.

Infections, too, can be a problem. The digestive system affects the immune system in ways we can't understand yet, and infections at the site of the surgery as well as other generalized infections may be a problem later.

There may also be psychological effects if the patient later fails to maintain a healthy weight, not an uncommon occurrence. Many patients don't follow the exercise and diet plan, assuming that having a smaller stomach is going to take care of things. Some patients have even overeaten to the point of bursting their staples, making emergency repair surgery necessary.

Long-Term Effectiveness of Obesity Surgery

The effectiveness of obesity surgery over time depends on the patient. Both my aunt and my mother had this surgery done in their late 30s. My aunt did well. She dropped at least half her starting weight and changed her eating habits, focusing more on vegetables and healthy meats than the fatty Southern cooking she'd been raised to. She's heavier now, but still maintained her loss pretty well.

My mother didn't do so well. She dropped a lot of weight at first too, but was unhappy because she couldn't eat as much. Instead of sticking to the diet, she started eating a little more each meal. She tried Lean Cuisine style meals - and they didn't satisfy her. Eventually, she was eating several meals per day. Soon enough, the part of her stomach that was accepting food expanded, and she put all the weight back on in just a couple of years.

Part of the difference was their exercise habits. My aunt is a restless person, and has always looked for active jobs. My mother's job involved sitting at a desk up to twelve hours a day. But part of it was also differing motivations. They both wanted to keep the weight off, but my aunt was more willing to make those critical changes.

In the end, if the patient is not willing to make serious permanent changes in his or her lifestyle, obesity surgery will not matter. The weight will come back, and it will bring all the original health problems back with it.

How Well Has This Been Studied?

So far, no one is certain what the long-term effects of obesity surgery are likely to be for teens. Weight gain is very complex, involving diet and exercise habits as well as genetics, social pressures, the environment, finances, and many other factors. Teen obesity has been a minor problem for decades, and little study has been done on it. And even though obesity surgery for teens has tripled over the last few years, it is still rare, with fewer than one percent of obesity surgeries performed on people aged 14-19.

The few studies that have been done on this operation at this age suggest that risks outweigh benefits for all but the most morbidly obese teens. For those who have had surgery, little study has been done on how well they maintain their weight loss, how fit they work to become afterward, and how it affects teens psychologically with identity issues and social situations. For instance, a young girl who is slender for the first time in her life will probably react differently from a thirty-year-old man who has attained the same success.

But what I find more disturbing than anything is how many of the bariatric surgery studies are funded by companies that have a vested interest, like Johnson & Johnson, which sells lap band kits and other obesity surgery tools. Without unbiased, long-term studies, we can't know the true risks and benefits of this serious procedure.