Thursday, June 29, 2006

Obesity surgery for teens?

Gastric Bypass Might Be A Smart Move For Teens

June 29, 2006 -- Gastric bypass is often seen as the magic bullet for those who desperately need to lose massive amounts of weight.

And while the surgery has its risks, its benefits (mainly reducing the risk of obesity-related diseases like heart attacks and diabetes) seem to outweigh the dangers, raising an important question: What about adolescents? Is teen obesity serious enough to warrant the surgery, too?

New research seems to suggest that the answer is yes. Brazilian doctors followed 42 children ages 13 to 18 for two years after they underwent gastric bypass surgery. These teens lost nearly half their body weight, and it cured those suffering from high blood pressure and type 2 diabetes.

The study is being presented today at a meeting of the American Society for Bariatric Surgery in San Francisco.

While this is good news, some doctors and dietitians remain cautious.

"While the surgeons are looking to show that bariatric surgery is appropriate for all age groups, the public health response should be a collective gasp: Has it come to this?" said Dr. David Katz, ABC News medical contributor. "We are so incapable of preventing obesity in our children, that we will send them to the operating room to fix it."

Doctors should be careful in recommending this surgery to obese teens before they know the long-term results of teens in a clinical trial, said Dr. Paul Shekelle, a health consultant at the RAND Corporation.

"Case reports like this are not sufficient to be the basis for a general recommendation for surgery in this population," he said.

Shekelle said he found "a less rosy picture" when he studied adults 10 years after they'd had obesity surgery. Most regained weight gradually, although they still had a significantly lower weight gain than those who did not have the surgery.

"This is not a quick-fix option," he said, noting that obese teens should not ignore the "upfront risk of the surgery and the lifelong rearrangement of the gastrointestinal system" when considering obesity surgery.

Plus, there is concern that most teens looking at surgery do not understand the long-term risks.

"The short-term gains are expected, but how are they doing long term is the question," said Madelyn Fernstrom, director of the University of Pittsburgh Medical Center Weight Management Center.

She and others also note that surgery alone isn't enough. There is still a lot of work to do, such as making massive dietary changes and exercising. Patients need to be wary of falling into old eating habits and regaining their weight.

"They get a 'do-over,' " said Fernstrom. "Anatomical adjustments make it easier, not easy, to lose weight."

Before surgery, Fernstrom's program requires obese teens to participate in a six-month lifestyle program.

Her medical center performs an initial screening with the teen and the teen's family to discuss their options and review what weight loss surgery can do to see if it is a good fit for the teen. After that, they undergo a complete lifestyle and medical evaluation.

"Surgery is the last step," said Fernstorm, who explains to teens that "this surgery is also for adults who have been on diets for longer than you have been alive."

There are a couple of avenues of thought, at least for me, where this is concerned. First, I think that surgical means are a completely acceptable and wonderful method for combating something that's been a problem for a very long time. The quote from the Katz guy about "has it come to this?" is a ridiculous one, in my estimation. "It's about time" is more appropriate... a "collective gasp from the public" is overdramatic at best. Please. There've been obese people, teens or no, for a long time. Yes, it does seem to be increasing in numbers, but I'm willing to lay odds that at some point someone's going to figure out why -- and it's not going to be laden with guilt over how we're raising our kids. There's more to the puzzle, we just haven't figured it out yet. In the meantime, here's a way we can help. Not cure, necessarily, and not for everyone, but here's one good way to help.

Having to endure adolescence as an average-sized person is bad enough. Enduring it with some obvious physical difference, whether it be misshapen teeth or severe acne or misaligned eyes, is torment. Unnecessary torment, in those cases, because we get braces and take Accutane and have eye surgery to fix those things. So somehow it's not acceptable to "fix" obesity? I don't buy that.

Surgical treatment of obesity, however, may not be the long-term fix that one would hope for. For a kid who loses the weight, becomes average-sized, and then is able to stay that way -- and there are those who will -- it's a life-saving miracle. For a kid whose results aren't quite that great, or who gains it back because they out-eat it or sidestep it... well, it's not going to help that kid.

Some of us who undergo bariatric surgery -- many of us, probably -- have a lot more psychological issues with personal appearance, food, what-have-you. There are self-destructive forces at work within us, rejection and anger and fear, things that prevent us from being able to use the surgical tool to its full effectiveness. For adolescents, however, those issues are in their formative stages and could be well-served by some good long-term counseling to help them deal with their new bodies better.

I think that bariatric surgery -- for teens and adults -- is a very good thing whose time has come, and I think it's underused. But I think that the psychology community hasn't caught up to it yet, which makes it less effective than it could be.

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