Copyright (c) 2009 Alma Orozco
Pediatric obesity has currently reached epidemic proportions, resulting in an increasing number of adolescents with morbidities related to obesity.
Obese teenagers have an increased risk of health as well as social problems due to their weight. These include serious conditions like arthritis, obstructive lung diseases like asthma, sleep apnea, high blood pressure, polycystic ovarian disease and diabetes mellitus (type2). Depression is especially common in this subgroup, as they are often subjected to social isolation and often, humiliation, by their peers.
Surgery options for obesity in teenagers need the attention of healthcare workers and researchers alike. This subgroup of patients is a unique cohort in terms of the fact that standard diet and exercise routines that work for obese adults are not applicable to them. Restrictive diets are not compatible with the teenagers’ life style, in fact they have been associated with weight gain over long-term follow up. This has been attributed to both, the rebellious nature of the teen psyche as well as rebound overeating when small goals pertaining to weight loss are reached.
Weight loss surgery for obesity in teenagers thus provides a logical solution for significant weight loss and for the co-morbidities in the most severe cases.
Also, many surgeons are of the view that bariatric surgery in adolescence decreases morbidity and healthcare costs long term, and results in a healthier adult population. Since in most patients the surgical procedure is inevitable, surgeons often believe that an earlier intervention is more prudent than waiting, since the outcome of bariatric surgery has been reported to be dependent on the duration of symptoms.
However, several bariatric surgeons believe that teenagers are not in a position to make an informed healthcare decision, as they lack the maturity to comprehend the ramifications of such a major surgery. Also, the lifestyle modifications required for the success of a weight loss surgery may be exceedingly difficult for an adolescent to deal with. Teens are at particular risk for noncompliance, as they are often unable to understand the consequences of their behaviors.
In spite of these doubts, teenage obesity has been tackled with surgery options .The long-term safety and effectiveness of bariatric surgery, however, is yet to be established in this group of patients.
As an extension of the LABS (Longitudinal Assessment of Bariatric Surgery) study, new study called Teen-LABS is now underway, to evaluate the risks and benefits of bariatric surgery in teenagers between the ages of 14 and 19.This clinical trial will compare the outcome of waiting until patients reach maturity before performing surgery to that of an earlier intervention in adolescents.
At present there is no data that establishes the longer term safety and efficacy of surgical options in obese teenagers. Indeed, Lap-Band has been approved by the FDA for use in adults only. However, anecdotal reports conclude that adolescents require less time in hospital, and recover faster than adults. Fewer surgical and post-operative complications and a significantly lower mortality rate mean that the surgery is relatively safer in this age group than in adults.
There are no clear cut guidelines for adolescent weight loss surgery: some surgeons begin to consider the option after a teen is 80-100 percent overweight, others believe that a surgical intervention is indicated only when a patient is between 100 and 150 percent over ideal weight. Most experts however agree that a successful resolution of obesity can only be expected in a teen who is less than 200 percent over their ideal weight for age. For patients more obese, the surgery will result in a significant weight loss, but many subjects will still remain morbidly obese. Medical problems that coexist also have a higher rate of resolution with a surgical intervention in the early stage of the disease.
Before a consensus is reached regarding the criteria for eligibility for surgery amongst teenagers, a long-term follow-up study is essential. This will determine the environmental, behavioral and genetic predictors of success, and also help predict the risks and benefits of surgery in this age group.
Bariatric surgery requires drastic lifestyle changes, prolonged follow up and has significant postoperative morbidity. Therefore, surgical options should be explored only in those obese teenagers who have failed to lose weight even after supervised dieting, intensive counseling and medications.
Alma Orozco is a certified patient coordinator of the Ready4Achange team for weight loss surgery in Monterrey, Mexico. Monterrey is rated as the safest city in Latin America and the medical facilities out there are certified by US hospitals. The low cost of living makes surgery very affordable in Mexico. You can check out Gastric sleeve surgery done by Dr Zapata at CIMA Monterrey by clicking on the link.