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    Dec. 10, 2013 (Washington, D.C.) -- Fifteen-year-old Jacob Miller’s body mass index, or BMI, was off the charts.

    More than 6 feet tall, Jacob weighed 702 pounds at his heaviest. An online BMI chart from the National Heart, Lung, and Blood Institute goes up to 443 pounds, which, for a 6-foot-4 individual, means a BMI of 54.

    Anything over 40 is “extreme obesity,” according to the chart. Doctors said Jacob’s was 83.

    But 6 months after getting weight loss surgery, Jacob’s weight has dropped to 535 and his BMI to 64. Those changes have led to improvements in his health, his surgeon, Thomas Inge, MD, PhD, told an audience Friday at a meeting of the American Society for Nutrition. Inge is surgical director for the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital.

    “How do we tackle pediatric obesity?” he asked. “We don’t have a great deal of success.”

    Weight Loss Surgery Pros and Cons

    For obese teens, especially the severely obese, simply trying to eat less and exercise more doesn’t seem to work, Inge says. He cites a 2012 Swedish study of 14- to 16-year-olds in which researchers found that after 3 years, lifestyle changes led to a meaningful BMI drop in only 2% of participants.

    Meridia had been the most effective weight loss drug, Inge said, but manufacturer Abbott Laboratories took it off the market in 2010 after research raised concerns about risks of heart attack and stroke.

    Inge says weight loss surgery “is costly and does have treatment risks,” but studies in adults have found that it has long-term health benefits. While the number of severely obese children and teens has grown for the last decade, the number undergoing weight loss surgery each year has remained stable at about 1,000.

    In 2004, his team published the first recommendations about weight loss surgery in teens. They advised that surgery be considered for adolescents with a BMI of 35 or greater who had serious obesity-related conditions, such as type 2 diabetes or obstructive sleep apnea. Among obese teens with less-serious conditions, such as insulin resistance and mild apnea, Inge’s team recommended considering surgery for those whose BMI is over 40.

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