The Miami Herald

Gastric bypass surgery an option for obese teens

When Amanda Rodriguez was in high school, she was one of the few students who had a key to the school elevator. At 292 pounds, she couldn’t walk up the stairs.

“It was really embarrassing and it took a toll on my mental state,” said Amanda. “I was just really unhappy with myself.”

After both her parents had gastric bypass surgery and lost weight, they encouraged her to undergo the same procedure. Serafin Rodriguez was worried about her daughter’s health, especially when she showed early symptoms of diabetes.

Three years after her surgery, the results are dramatic.

Now 19, Amanda lost about 120 pounds. Last year she left home to study psychology at the University of Connecticut, and proudly describes how she can walk around the hilly campus.

“I thought I was going to be riding a bus constantly,” she said. “But now I’m able to go on school field trips and kind of interact with really cute guys, which is something that I did not think I was going to be able to do on a college campus all the way in Connecticut.”

Amanda’s case is part of a nationwide study of 890 adolescents who have had bariatric surgery. The study, released in March, followed up three, six and 12 months after surgery. The patients were between 11 and 19 and lost an average of 66 pounds. Sarah Messiah, Ph.D., one of the study authors at the University of Miami Miller School of Medicine, hopes the results will encourage more pediatricians to consider the procedure as an option for young people.

“To me you’re just kicking the can down the road while they get sicker as adults,” Messiah said. “For adolescents who do undergo the surgery, it’s the first time in their life that they feel really good. It’s like they have a second lease on life.”

There are three main kinds of bariatric surgery. Amanda and her parents had gastric bypass surgery, the most common procedure. This involves redirecting the small intestine to a stomach pouch that limits food intake. The average weight loss for these teens in the study was 107 pounds.

Patients who opted for the less invasive gastric banding lost an average of 44 pounds. In this procedure, an adjustable band is inserted around the stomach, like the thin part of an hourglass, to restrict the size of the stomach.

The third kind is a gastric sleeve, in which doctors remove a large portion of the patient’s stomach so that it takes the shape of a sleeve. None of the adolescents in the study had this procedure.

Obesity rates in the United States have doubled for adults and tripled for children between 1980 and 2008, according to the Centers for Disease Control and Prevention. Given this, medical professionals are looking at all options to help patients attain — and maintain — a more healthy weight.

Candidates for bariatric surgery are identified by body mass index (BMI) rather than weight. Patients with a BMI of 40 or higher qualify — an example would be a girl five-feet-five weighing about 250 pounds.

Dr. Mary Brandt, the director of the Adolescent Bariatric Surgery Program at Texas Children’s Hospital, says that younger candidates for this surgery should not be judged by the same criteria used for obese adults. For the benefits to be worth the “permanent and life-changing” effects of surgery, a teenager must exhibit serious health conditions such as diabetes, high cholesterol, fatty liver or hypertension.

“With younger patients, it’s possible to prevent the progression of these diseases,” said Dr. Jaime Ponce, the president of the American Society of Metabolic and Bariatric Surgery. “Kids have less risk of immediate complications because there’s less damage from other problems. They haven’t damaged their joints from years of being overweight. A teen or an adult has the same risk, but younger bodies heal and recuperate better.”

The side effects, especially malabsorption of vitamins, could have more serious consequences for young people as their bodies are not fully developed, he added. He recommends tests to evaluate both physical factors such as bone density and psychological factors such as maturity and ability to make lifestyle changes.

Brandt prefers to go by development indicators, rather than age, to make sure children are almost all the way through puberty; for boys between the age of 15 and 16, for girls, between 13 and 14.

Dr. Nestor de la Cruz-Muñoz, the bariatric surgeon at the University of Miami Hospital who performed the surgery on Amanda and her parents, has operated on patients as young as 13, but says that under the right conditions, he would consider it a last resort for children as young as 9 or 10. Less than 1 percent of his patients are adolescents.

“Bariatric surgery is going to keep on growing because the evidence gets greater every year of the benefits,” he said. “Physicians are much more accepting now than they were a few years ago. They’re starting to understand it, and hopefully in the next few years the public will be more understanding.”

Some experts worry that as this surgery becomes more widely available, the rigorous standards of vetting potential bariatric surgery patients will not be upheld.

“There is some thinking in the field that in a few decades, that this is going to become a cosmetic thing. Already in Colombia or Brazil you can just go get your band in,” said Messiah, referring to the widely advertised Lap-Bands. “There are places in South Florida that are always advertising. But they don’t have properly trained surgeons … some places have even had deaths.”

Experts agree that a quick fix for adolescent obesity is a dangerous and inaccurate promise. Centers that specialize in bariatric surgery for this demographic offer an infrastructure of age-specific counseling, including pediatric nutritionists and adolescent psychologists. Most surgeons require that teens get six to 12 months of counseling before the doctors will consider bariatric procedures.

“There are certain patterns that they’ll have to develop,” said Sheah Rarback, director of the nutrition division for the Mailman Center for Child Development at the University of Miami’s School of Medicine. “A lot of obese people are fast eaters, so we talk about slowing down, practicing mindful eating, how to measure portion sizes. If you’re dealing with a child who has a BMI of 35, 40, 50, which is high even for an adult, you’re going to see some very unhealthy eating habits.”

Amanda adamantly reminds people that her surgery “wasn’t magic,” and that she has had to work hard to maintain her weight loss.

She describes her eating habits before her surgery as “insatiable hunger,” acknowledging some “comfort eating” and some “boredom eating.” But more than anything, she says that because she was so obese, her stomach constantly felt empty.

Now, after her surgery, Amanda says that she doesn’t feel the same hunger, but she admits running into trouble when dealing with the stress of moving away from home.

“I feel definitely that emotional eating would play more now than hunger,” Amanda said. “I’m struggling with it currently. I mean, it’s my first year of college.”

The family dynamic was complicated when Amanda was growing up: two obese parents, a very skinny sister, and two normal-size brothers. Her father weighed 392 pounds before his gastric bypass surgery in January 2007 helped him lose 140 pounds. Her mother had the same surgery four months later, which brought her from 296 pounds to 155 pounds, after she had 20 pounds of loose skin removed from her abdomen.

As Amanda’s mother shared family pictures from pre-surgery, she explained that Amanda “got the fat gene” in the family; that her daughter “hasn’t had a thin day in her life.”

Amanda is looking forward to joining the marching band in her sophomore year. She’ll be able to hike around the woods of Connecticut this summer at band camp.

Even though the recovery and lifestyle adjustments were harder than she thought it would be, Amanda says she would still recommend the procedure to other obese adolescents.

“If this is a real option for you and you’ve tried dieting, then this is what you should do,” she said. “Why are you going to risk your entire life, develop a heart problem or diabetes, when this is something you can do early on and your life can completely change?”




© 2012 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com