Obesity: Operating on a teen epidemic
by Dr. Mary Brandt, Angie's List contributor
When colleagues first presented me with the idea to start performing bariatric surgery on adolescent patients 10 years ago, I wasn't only skeptical, I was worried.
I knew then as I know now that obesity has a profound impact on a person's health. Still, teenagers aren't adults; their bodies aren't fully developed and surgery always has risks. On the other hand, adolescents suffering from morbid obesity have a shorter life span and face health problems ranging from sleep apnea to fatty liver to depression.
To make young people wait for treatment until they're adults might increase their risk. In 2004, with guidance from another bariatric surgeon, I began performing the procedure on teens. With adolescent bariatric surgery still in its infancy, doctors must take extra care in determining who is a good candidate.
A patient must be 13 or older and have a body mass index of 40, well beyond the base threshold for obesity, and related health problems, such as Type 2 diabetes. Then begins months of preparation leading up to surgery.
Azareth Torres, a 16-year-old from Cypress, Texas, began the program at Texas Children's Hospital in December 2009. In addition to being overweight, she had sleep apnea, insulin resistance - which increases her chances of developing Type 2 diabetes - high cholesterol and high blood pressure, among other health problems.
One of the most important aspects of our program is our support group that meets twice a month. Patients begin to change their lifestyle as they learn about healthy eating habits and options for physical activity. The program isn't easy; it's time consuming and takes real devotion on the part of the patients and their families.
After six months in the program, it was evident Azareth - who'd stopped snacking after school, reduced portion sizes, eliminated soda, started taking a dance class and went to the gym regularly - was committed to making a lifestyle change. She said the surgery gave her hope.
She underwent a battery of tests and met with our specialists, including a registered dietitian and psychologist, who determined she was ready to have the operation done. Azareth underwent the Roux-en-Y gastric bypass surgery in July.
For this procedure, stapling is used to create a small, upper-stomach pouch that restricts the amount of food a person can consume. A portion of the small bowel is bypassed, delaying food from mixing with digestive juices to avoid nutrient absorption.
Our involvement doesn't end with surgery. We're committed to coaching our patients for at least 10 years after the procedure. Preliminary data from our research reveals teens who undergo bariatric surgery show a dramatic remission of their Type 2 diabetes, along with lower blood pressure and cholesterol levels.
Azareth lost 68 pounds in the first three months after the operation and her blood pressure is back to normal. We fully expect her to lose more and, though it's too early to determine the impact on other related issues such as insulin resistance, we hope the procedure will eventually resolve all her health problems.
Dr. Mary Brandt is director of the Adolescent Bariatric Surgery Program at the highly rated Texas Children's Hospital, and professor of surgery, pediatrics and medical ethics at Baylor College of Medicine in Houston. She is one of five pediatric surgeons in the U.S. receiving funding from the National Institutes of Health to study bariatric surgery in adolescents.