The debate over adolescent bariatric operations

Operations to treat obesity are proven to help in many cases but remain controversial

“What happened to young people being active? Don’t parents make young kids and teens go out and play anymore?”

“Why the heck aren’t these kids tossed in a gym and given reasonable, healthy food to lose weight? Americans are too desperate for a quick fix that they don’t have to put any effort into!”

These are just a few comments people made in reaction to a news story about teenage bariatric surgery. Though the commenters’ concerns aren’t entirely off base, the “Pick yourselves up by the bootstraps” mentality represents a lot of misconceptions about childhood obesity and its treatments. No one’s denying the importance of exercise and parental influence in the battle against childhood obesity, but citing it as the epidemic’s only contributing factors is a gross oversimplification.

For starters, maintaining a healthy weight involves a lot of elements, some of which are outside the control of parents and kids. Access to reasonably priced fresh fruits and vegetables and clean, safe parks for kids to play in (not to mention enough parental free time to cook and play with kids) are important for fighting obesity. Without them many families are at a distinct disadvantage for helping their children maintain a healthy weight. And while science doesn’t fully understand all the factors that lead to patients becoming morbidly obese, it’s believed the cause is a combination of genetic predisposition and environmental factors, much like many other medical conditions. It’s an issue of national concern, and in the most severe obesity cases, bariatric surgery may be the most medically sound option.

Brad Linden, MD

“The medical community has long debated the ethics of bariatric surgery for young patients, but that debate is coming to an end because we now have data to indicate that, in select cases, the health benefits of bariatric surgery outweigh the risks in adolescent patients,” said surgeon Bradley Linden, MD, director of the new Adolescent Bariatric Surgery Program at Children’s Hospital Boston. “When left untreated, severe obesity can lead to serious medical conditions like type 2 diabetes, high blood pressure and cholesterol and fatty liver disease. But there’s a window of time where the long-term effects of morbid obesity are more reversible, which leads us to believe that earlier intervention is important. It has gotten to a point where we worry that if we don’t offer bariatric surgery to these patients, we may be withholding life-saving therapy.”

The Children’s program will focus primarily on three different laparoscopic weight loss operations, but based on the program’s strict guidelines, only a small number of patients will be eligible. In general, the candidate must have a body mass index (BMI) of 35 or greater, suffer from obesity-related health conditions, been unable to lose weight through other medically supervised dietary and exercise programs and show a strong willingness to alter their diet and lifestyle permanently.

“Bariatric surgery is a commitment to healthy lifestyle, not just a few hours in the operating room and a week or two of recuperation,” says Linden. “The right diet and exercise figure prominently into treatment because without a commitment to change, patients can end up not achieving what they need for their health after enduring the risks associated with having an operation.”

A permanent commitment to a healthy lifestyle is a required for bariatric operations to be successful.

As with any operation, bariatric operations have risks. Studies show short and long-term complications may include infection, hernias and, if patients do not follow-up closely with their program, vitamin and nutritional deficiencies. These are serious concerns, but for a Children’s patient to be approved for weight loss surgery, Linden says much effort will have already been taken to ensure that the benefits will be far greater than the risks.

“Complications like pneumonia, infection and post-operative hernias are rare for these operations, but they are always on our radar,” he says. “Our pediatric surgical team is well equipped to manage risks before, during and after surgery.”

As long as the obesity epidemic continues to adversely affect the long-term health of children and strain America’s healthcare system, conversations about adolescent bariatric surgery will continue. But by better informing people about the science and facts behind obesity and its treatment it’s possible that we can shift the tone of the discussion. By looking at obesity and obesity treatment in a more individualized way, instead of as a blanket issue, may be we can initiate conversations that are more focused on personal solutions than assigning blame.