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Weight Loss Surgery for Severely Obese Teens

Jacob's Story

Jacob, who allowed Inge to discuss his case and show before-and-after photos, had a variety of ailments related to his weight, including type 2 diabetes, depression, stage 2 chronic kidney disease, sleep apnea, high blood pressure, chronic fluid buildup in his legs, high cholesterol, and a weakened heart, Inge says. The fluid buildup and diabetes raised his risk of cellulitis, a bacterial infection of the skin, and he required multiple hospital stays for treatment.

Jacob chose gastric bypass surgery, which has the longest track record -- more than 30 years -- of the three main weight loss operations. The surgeon creates a small pouch in the stomach, disconnects it from the first section of the small intestine, and reconnects it lower down. With Jacob, as with most gastric bypass patients, the operation was done with tools passed through tiny incisions in the abdomen.

A popular alternative is called laparoscopic “sleeve gastrectomy,” Inge says. Surgeons remove 80% of the stomach. What’s left is shaped like a sleeve or tube. 

A third weight loss operation is gastric banding. An implantable band that can be loosened or tightened closes off part of the stomach. It is approved only for people 18 and older.

Six months out from his surgery, Jacob no longer has diabetes or high cholesterol, but he’ll probably never have a normal BMI, Inge says. He thinks there might be an undetected medical problem that caused Jacob’s weight to balloon.

Risks and Benefits of Surgery

Teens like Jacob and their families might take heart from a study Inge and his team published last month in JAMA Pediatrics. The study covers problems within the first 30 days after weight loss surgery in 242 adolescents, whose average age was about 17 and average BMI 50.5.

While 19 people, or 8%, had major complications, including the need to reoperate, minor complications (such as readmission to the hospital for dehydration) were seen in 36 of the adolescents, or 15%. There were no deaths during the study period.

Inge and his team are continuing to follow this group to study the long-term risks and benefits of weight loss surgery.

In an accompanying editorial, Michael Sarr, MD, a surgeon at the Mayo Clinic in Rochester, Minn., noted that weight loss surgery can improve teens’ physical  and mental health, which is especially important during adolescence. “Those of us who treat these patients, both as adolescents and adults, appreciate the problem of social isolation (the important elephant in the room not often acknowledged),” Sarr writes. 

To support Sarr’s point, the “after” photo Inge showed the audience at the nutrition meeting featured Jacob with his homecoming date.

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