With the U.S. obesity epidemic showing no signs of slowing down, many people who suffer from the effects of severe obesity, typically defined as being at least 100 pounds overweight, have turned to weight loss (bariartic) surgery in order to improve their health and overall quality of life. Despite mounting scientific evidence supporting the use of bariatric surgery as an effective means of reducing excess weight in the severely obese population, the number of children undergoing such operations has remained relatively small. Best estimates in the U.S. suggest that approximately 1,500 to 2,000 surgical weight-loss procedures are carried out in the adolescent age group each year. Despite a number of unanswered questions related to weight-loss surgery in teenagers, a increasing number of studies specifically designed to address its safety and effectiveness in the younger age group, coupled with recent reports highlighting the many health-related medical problems that severely obese teens face (i.e. high blood pressure, Type 2 diabetes, liver disease, depression, etc), a national consensus in support of this previously controversial treatment regimen has emerged.
Even in the face of recent outcomes demonstrating very encouraging results among adolescents undergoing bariatric surgery, which are similar to results seen in the adult population, a number of misconceptions continue to swirl around the medical community and the general public. One of the most common misconceptions about bariatric surgery, and one that is often a topic of conversation in centers that exclusively treat severely obese teens, is the idea that somehow the decision to undergo a bariatric operation represents a patient’s decision to throw in the towel or seek “the easy way out”. In fact, a recent report illustrating the program characteristics of the five adolescent bariatric surgery centers that participate in the ongoing Teen-Longitudinal Assessment of Bariatric Surgery ( Teen-LABS) Study, a National Institutes of Health-funded project designed to assess the safety and effectiveness of 242 teens undergoing bariatric surgery, shows that teens and their families spend between 8 and 14 months preparing for bariatric surgery. From the time a teen enters into one of these representative programs, they and their family members and/or support individuals spend a considerable amount of time undergoing required medical and psychological testing as part of the routine approval process. In addition, and equally as important, would-be patients participate in in-depth educational sessions designed to improve healthy lifestyle choices that are vital for successful weight loss following their surgical procedure. The complexity of the assessment process and one-on-one educational counseling that occurs both before and after adolescent bariatric surgery clearly demonstrates that the decision to undergo a surgical weight-loss procedure is anything but an easy way out or a “quick fix.”
Another common misconception about severely obese adolescents is that their state of health is a consequence of laziness, lack of self control or will power, bad parenting or simply the result of too much time in front of the television and/or video game console. While it is tempting to assign blame to any combination of these and other seemingly logical factors, no set of environmental or behavioral variables has been clearly linked to the development of severe obesity. In fact, as a pediatric surgeon who specializes in the field of surgical weight loss for teens, I can state with total certainty that these factors rarely, if ever, come into play, particularly the notion that adolescent obesity is the result of “bad parenting.” As mentioned earlier, the level of commitment and dedication that is required from all family members who partake in bariatric surgery bespeaks the high quality of parenting for this true “family affair.” Furthermore, it has become exceedingly evident that discussing social misconceptions among patients and families, including a frank conversation about societal factors and challenges that the severely obese population face on a daily basis, are as important as discussing the specific details related to the actual operation and what changes to expect following surgery.
In addition to the commonly observed tendency to assign individual blame, another common misconception relates to the ease or difficulty of attempting to lose weight through traditional (i.e. non-surgical) means. While the diet and exercise market is filled with a multitude of self-help guides offering advice on nutrition, exercise and behavior aimed at reducing excess weight, very little information is available to the general public on the overall success rates. And speaking of success rates, a related misconception is that the mere accomplishment of losing weight is somehow synonymous with the vastly more important, and certainly more challenging, accomplishment of maintaining that weight loss. Certainly we all know people who have shed vast amounts of weight through one fad diet or another, only to gain the weight right back once their goal weight is achieved. To date, a number of large studies in adults with severe obesity designed to measure the ability to lose weight and keep it off using diet and exercise programs, commonly referred to as “durable” weight loss, have shown disappointing outcomes at best. The results of similar studies in children are equally discouraging due in no small part to a multitude of challenges commonly encountered during the adolescent time period.
Bottom line: The decision to undergo a bariatric operation at any age has life changing consequences and should be considered very carefully. For teens in particular, it is important to seek the support of family or close friends and to locate a center that has experience in performing weight-loss surgery for the teenage population. Most importantly, it is critical to understand that the decision to move ahead with bariatric surgery is supported by an increasing number of studies showing that such operations are safe and effective and should never be thought of as an easy option.
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Weight-Loss Surgery for Kids: a Good Idea, Despite Many Misconceptions originally appeared on usnews.com
