Surgery for Obese Teens Increasing, But Not a 'Quick Fix'

Fewer than 1,000 US teens have bariatric surgery each year (compared to between 200,000 and 250,000 adults), but that number is on the rise and, experts say, cause for concern and education about the risks and benefits of the procedure.

"There's certainly more and more cases done every year, and unfortunately we're likely going to continue to go that route," says Evan Nadler, M.D., the director of bariatric surgery and codirector of the Obesity Institute at the Children's National Medical Center, in Washington, D.C.

Success stories like...celebrities...Al Roker and Star Jones might make bariatric surgery look easy. It's not. In fact, doctors are so concerned that teens might have unrealistic expectations that they require extensive presurgery evaluation and lifestyle changes to ensure that teens understand the serious risks, are dedicated to overhauling their health, and don't take the procedure lightly.

Surgery usually requires preliminary weight loss and then a strict postsurgical regimen of dietary changes, vitamins, and exercise. If the teen and his family aren't fully committed, the results can evaporate quickly or fail to materialize in the first place.

"We worry a lot if we have a child who thinks the surgery is going to be a magic fix," says Eleanor Mackey, Ph.D., a clinical psychologist at the Obesity Institute at Children's National Medical Center, who evaluates young people considering the surgery.

Bariatric surgery is not for the moderately overweight. Although there are no consensus national guidelines for bariatric surgery for adolescents, doctors generally follow the same national guidelines for adults: The patient should have a body mass index (BMI) of 40 or higher (for example, someone 5'4" would have to weigh at least 233 pounds to qualify), or a BMI of 35 (a weight of 204 for someone 5'4") or greater with serious obesity-related health problems, such as type 2 diabetes.

"This is not a cosmetic procedure," says Marc Michalsky, M.D., surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, in Columbus, Ohio. "Most of these kids are actually quite sick, and they feel quite sick...."

It takes a team of pediatricians, psychologists, exercise physiologists, dietitians, and social workers to get a true sense of whether a teen is ready for the surgery and to help that patient prepare for the surgery and follow-up.

For instance, surgeons typically require that a patient make lifestyle changes-- becoming more active and eating healthier -- before undergoing the surgery.

Doctors can evaluate whether a patient has made sufficient changes by tracking her weight and performance in a quarter-mile walk test, [Thomas Inge, M.D., the surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children's Hospital Medical Center] said.

"We really look to make sure that kids are interested in the surgery, that they're not just being pushed into it, [and] that they have some understanding of what they're going to have to do to make sure their surgery is successful," Mackey says.

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