Bariatric surgery, commonly known as weight-loss surgery, can be a safe and effective treatment for a teen or young adult whose obesity has persisted despite all medical efforts, and who has complications of obesity. Dr. Camilla Richmond, medical director of the Adolescent Bariatric Surgery Program at Boston Children’s Hospital, answers common questions about weight-loss surgery at Boston Children’s.
Who is eligible for bariatric surgery at Boston Children’s?
We evaluate each potential patient on a case-by-case basis, but generally speaking, children over age 12 with a body mass index (BMI) of 35 or over and one or more weight-related illness, such as obstructive sleep apnea, type 2 diabetes, benign intracranial hypertension (pseudotumor cerebri) or nonalcoholic steatohepatitis (NASH) are candidates for bariatric surgery. Anyone with a BMI over 40 is also eligible, regardless of weight-related illnesses.
We require all potential patients seeking evaluation for weight-loss surgery to have already tried other methods to lose weight — preferably a medically supervised weight loss program with assistance from a dietitian.
Is weight-loss surgery covered by insurance?
In most cases, yes.
How do your patients decide to undergo weight-loss surgery?
Patients come to this decision in a variety of ways. Many have parents or family members who have also had weight-loss surgery and are very familiar with the benefits. Others are encouraged to look into it by their primary care doctor or find us themselves by doing research online.
The timing and drivers of the decision to pursue weight-loss surgery are different for everyone. Many of our patients decide that surgery is right for them once they have been diagnosed with significant weight-related health problems — for example, sleep apnea, type 2 diabetes, chronic headaches associated with brain swelling and fatty liver disease.
What are common misconceptions about weight-loss surgery?
- Weight-loss surgery is not appropriate for teenagers. Adolescence and early adulthood can actually be the best time for certain patients to have bariatric surgery. Compared to adults, younger patients are generally more likely to experience improvement or even full resolution of their health problems after surgery and lower post-surgical weights. This is because they’ve had health problems related to their weight for a shorter period of time and they’re often at a lower BMI at the time of surgery.
- Weight-loss surgery will affect growing bodies. Research has shown that children who have had bariatric surgery actually end up slightly taller than kids of similar weights who have not.
- Weight-loss surgery is a cosmetic “quick fix” for people who don’t have the willpower to make changes. This could not be further from the truth. Like many weight-loss surgery programs, we require our patients to participate in an intensive program for at least six months (and often many more) before surgery. During this time, we see patients frequently to help support the diet and lifestyle changes necessary for long-term success and to manage any other medical and mental health conditions they may have.
What is special about Boston Children’s Adolescent Bariatric Surgery Program?
Our program was the first adolescent surgical weight loss program in the country to be accredited by the national Metabolic and Bariatric Surgery Association Quality Improvement Program (MBSAQIP). We are a dedicated team at the #1 children’s hospital in the nation, with members from the divisions of gastroenterology, nutrition, endocrinology, sleep medicine, gynecology, psychology, plastic surgery and neurology.
Our approach to each patient and family is very individualized because we believe that everyone’s history and experience with weight is different. Our focus is on helping all our patients optimize their health, diet and lifestyle to maximize long-term success after surgery.
What is recovery like?
Patients usually spend two to three days in the hospital after surgery and then are home for another two weeks before returning to school or work. They can only drink liquids for the first two weeks and then can gradually expand what foods they can eat over the next two months.
What change do you see in your patients’ overall health?
The changes after surgery are incredible. Almost all diabetic patients who needed insulin before surgery no longer require it immediately after surgery and 95 percent of patients with sleep apnea who need breathing machines can stop using them six months after surgery. Three years after surgery, most patients have kept off the weight and have dramatically reduced risks for cardiovascular and metabolic complications.
What we hear most from patients is how much more energy they have after surgery, which affects their whole outlook on life. It’s amazing to watch and support these teens and young adults as they change both physically and emotionally.
Learn more about Boston Children’s Adolescent Bariatric Surgery Program.