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Health Resources
Time to Lose - Gastric Bypass Surgery in Teens
"As advocates for children we
recognize there is an epidemic of child and
adolescent obesity," says Craig Albanese,
M.D., chief of pediatric general surgery at
Lucile Packard. "There's a long standing
history of programs geared toward prevention
and also ongoing treatment for children and
adolescents here at Lucile Packard, and quite
frankly for adolescents the non-surgical
management has not been very effective for
long-term weight loss. And more and more kids
are obese younger and therefore suffering
severe complications of which the bets and
only durable, long-lasting treatment is the
gastric bypass or surgical treatment for
obesity.
ONE STORY
"She
little started being on a diet from the time
she was 3 years old and she was Weight
Watchers' youngest member at 5 because she was
already morbidly obese," Guy recalls. "And
mind you I had her in swimming all Summer
long, softball, ice skating and ballet since
she was 2 1/2, so it's not like this wasn't an
active kid. But it got to the point that as
she got older the weight just kept piling on."
As she
daughter's weight became more of a problem,
Guy decided to look into gastric bypass
surgery the best way she could think of - she
had it done herself. "I myself was 300 pounds
and I thought if my daughter's going to go
through this I want to know what she's going
through," she explains.
By
the time Guy had the surgery performed, her
now 13 years old daughter was beginning to
have further medical complications. "She was
at 295 pounds and she was breaking her ankles
about every three months and they would never
heal," she says. "She was also
developing diabetes, she has sleep apnea and
her heart was shunting over." "Forty pounds off a 5-foot 1 inch frame at 13 years old was not enough to reserve her medical problems - it's like picking a hair off an elephant and she wasn't getting better," Guy says, "And we didn't do this to make her look good - we dud this to save her life." So at the age of 14 1/2, her daughter went back to have her previous surgery revised to a full Roux-en-Y gastric bypass, which creates a very small stomach pouch that is able to only hold one ounce of food at a time. Since the surgery half a year ago, Guy's daughter has lost another 55 pounds and has seen some improvements. "She is doing very well and she hasn't broken her ankles since then, her heart looks like it's starting to repair, her diabetes is completely taken care of and she doesn't need to sleep with her sleep apnea machine at all," Guys says. "So big positive changes, not to mention the teen-age self-esteem and everything else. It's been wonderful for her. AT THE BEGINNING While gastric bypass surgery was able to aid Guy's daughter surgeons involved with this procedure stress that weight loss surgery is not for everyone and is only for the most extreme cases. "It's not something that someone can dial a phone or hit the Website and say I want my kid to lose 80 pounds, do the operation," Albanese states. "It just doesn't work that way." In fact, in order to be considered a candidate for gastric bypass, a teen hast o try everything else before it's even an option. Albert wetter, M.D., of the El Camino weight Loss Surgery Program and Director of bariatric surgery at the Peninsula Medical Center - Who also performed the surgeries on both Guy & her daughter says candidates must be no younger than 13 for girls or 14 for boys and must be at least 100 pounds overweight with medical problems, such as hypertension (blood pressure issues), diabetes, sleep apnea (sleeping with the aid of breathing machine) or significant joint issues. "We chose those ages because by then most of the bone development is already established so we don't effect too much of the development of the adolescent," he says. In addition, candidates must have failed a supervised medical weight-loss program. "Both the adolescent and parents got to a nutritional therapist and nutritional counseling for eating habits and they also go for psychological or psychiatric counseling to ensure that they are not using the weight as a tool to achieve any other psychological issues they may have," Wetter explains. "We try to address these issues even before considering surgery."
At the Cincinnati Children's Hospital, which
has been performing gastric bypass surgery on
adolescents for the past three years, the
hospital team examines a candidate's medical
history, weight-loss history, family structure
and psychological well-being to see if the
surgery is right for them, says Thomas Inge,
pediatric surgeon and assistant professor of
surgery and pediatrics and surgical director
of the comprehensive weight management center
at the hospital.
"We look their
history over carefully and look them over
carefully, really looking for at least six
months of organized weight loss attempts in
the past, looking for any evidence from their
history that would suggest they're not going
to be compliant with the post operative
instructions," he says.
And by having so many specialists as part of a
program that selects potential candidates also
helps to ensure that if the surgery is
performed, it doesn't end up being for
nothing, Albanese says.
"What we don't want to happen is to perform a
surgery sort of recklessly in that yes it
works, but only for a short period of time
because we haven't done anything else to
change lifestyle and behavior," he explains. "
So yes, it will be fine for the first year,
but they could stretch the pouch or overeat or
eat high caloric milkshakes or snacks
incessantly and that will ruin it. So if we
didn't do anything for the behavior or
anything for counseling or anything for family
support systems, well now we've done an
operation - a risky operation - and we've done
the kid no good and they're back to square one
a year or two later. That's why it's
important to have this multidisciplinary
approach."
Continued on "Gastric
Bypass - Risk & Expectations - Weighing the
Cons"
KidsHealth.org
- KidsHealth is the largest and most visited site
on the Web providing doctor-approved health
information about children from before birth
through adolescence. Created by The Nemours
Foundation's Center for Children's Health Media,
KidsHealth provides families with accurate,
up-to-date, and jargon-free health information
they can use.
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