For Severely Obese Teens, Surgery
April 17, 2001 -- Your child has tried everything from fad diets to nutritional advice and obesity clinics, but the pounds keep piling on. You're concerned not only about the psychological consequences of being severely obese but also the physical ones. Is there any other option? Yes! It's a drastic solution -- even for adults -- but for extremely obese teenagers with no other alternatives, surgery can help.
The procedure, called gastric bypass, is not for every overweight teen. Only those who weigh more than twice as much as they should and who have failed both weight-loss and behavior-modification programs should even be considered, suggest Richard S. Strauss, MD, and colleagues at Robert Wood Johnson School of Medicine in New Brunswick, N.J.
"Gastric bypass remains a viable last-resort option for a limited number of severely obese adolescents for whom other comprehensive dietary and behavioral approaches to weight loss have been unsuccessful," Strauss and colleagues note in the April issue of TheJournal of Pediatrics.
The surgery is commonly called stomach stapling, although doctors prefer the term "gastric bypass." The idea is to reduce the size of the stomach to a small pouch that can hold only about two tablespoons. This is done by using a special surgical tool to staple across the top of the stomach. A narrow part of the small intestine is then attached above the staple line so that food passes directly from the small stomach pouch into the intestine. Because of the small size of the stomach pouch and the narrowness of the opening at the bottom, the surgery makes it impossible for a person to eat a large meal.
Strauss and co-workers report the long-term results from 10 teens aged 15-17 who underwent the surgical procedure. These three boys and seven girls each originally weighed an average of more than 325 pounds.
Seven of the teens had terrible problems due to their weight. One 392-pound boy refused to go to school because he was so severely teased by his classmates. The two other boys had dangerously high blood pressure, two of the girls had severe trouble breathing at night, and another girl's back was literally breaking under the strain of her weight.
The teens have been monitored for at least one year and as long as 10 years. All of the surgeries went well. Nine of the 10 teens had persistent weight loss -- nearly 118 pounds on average and almost two-thirds of their excess weight. The 392-pound boy lost 183 pounds and was able to go back to school. The patients with breathing problems and high blood pressure got better. And three of the girls -- including one who did not lose weight -- had normal pregnancies.
Yet, there were some problems. One girl developed malnutrition and had to be treated in the hospital. Two other patients had gallstone surgeries, and one patient required surgery to correct a small-bowel obstruction 10 years after the stomach surgery.