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Tuesday, Nov 24, 2009
An increasing number of obese teens are opting to undergo stomach staplings. Are they trading one type of hell for another?
Mar 16, 2004 | Even as a child, Natalie Moore, 19, was aware of her weight. When she announced to her Yoder, Ind., kindergarten that her favorite animals were pigs, a classmate shouted, "That's because you are a little piggy!" By age 10, Natalie, already a Size 28, had been called "pig, cow, hippo -- really any type of large animal," she says. "When I walked down the hall, kids would say, 'Here comes an earthquake!'"
Coming home from school in tears was bad enough, but in eighth grade, Natalie, weighing well over 250 pounds, began experiencing mild heart attacks. "It was very scary," she says. "My doctor told me I only had a year to live if I didn't lose weight."
Going on a strict 1,500-calorie-a-day diet, Natalie managed to lose 40 pounds in six months, but the weight -- due to a family history of obesity as well as a sedentary lifestyle and cravings for Mountain Dew and HoHos -- gradually crept back on. After reading about weight-loss surgery on the Internet, and then discussing the procedure with her parents and her pediatrician, Natalie went for a consultation at Cincinnati Children's Hospital's Comprehensive Weight Management Center, one of the only places in the country that performs gastric bypass surgery on adolescents. On May 18, 2001 -- a month before her 16th birthday -- Natalie's insurance paid for her to undergo a gastric bypass, in which her stomach was divided and stapled down to the size of an egg.
Despite medical complications -- including a distended bowel that required immediate follow-up surgery -- and a drastic change in lifestyle that requires Natalie to subsist primarily on skinless chicken breasts, sugar-free Flintstone vitamins, and 64 ounces of water or Crystal Light a day, the college freshman, who now weighs 150 lbs, is absolutely convinced the surgery was worth it.
"I would do it a hundred times again if I had to," she says.
The popularity of gastric bypass surgery has soared in recent years, thanks in part to the dramatic weight losses of celebrities such as Carnie Wilson and Al Roker. According to the American Society of Bariatric Surgery (ASBS), more than 100,000 adults underwent weight-loss surgery in 2003, up from only 16,200 in 1992. Many insurance companies now cover at least part of the cost, which averages $25,000. While there are no official statistics as to how many adolescents have undergone weight-loss surgery -- estimates range from 150 to 1,000 -- the numbers, like those for adults, appear to be on the rise. And with childhood and adolescent obesity a national epidemic, Dr. Thomas Inge, surgical director at Cincinnati Children's Comprehensive Weight Management Center, believes as many as 250,000 teenagers may be good candidates.
"Obviously, prevention of obesity is key," he says, "but prevention failed a decade ago for Johnny, who's now 400 pounds."
But the question remains: Do the results outweigh the risks? The fatality rates, at least among adults, are relatively high -- about one in 200 adult patients die from weight-loss surgery each year in the United States, and many develop hernias, blood clots and serious infections. During a gastric bypass operation, which typically lasts between one and three hours, doctors divide the stomach, stapling the lower section into a pouch. The gastric tract is then rerouted so digestion occurs in the lower small intestine, reducing the amount of calories and nutrients the body can absorb and making long-term nutritional deprivation a potential problem. Critics contend these complications may be exacerbated in adolescents, whose bodies aren't yet fully developed. They also worry that many young patients might not be mature enough to understand that by undergoing bypass surgery, they are signing up for a drastic lifestyle change.
"We're looking at a 50-year postoperative period," says Paul Ernsberger, associate professor of nutrition at Case Western Reserve University in Cleveland. "What are the chances the weight loss will last that long? What are the long-term consequences of deliberately sabotaging the digestive process? ... Teens are not qualified to make decisions that will affect their health for the rest of their lives."
Still, despite the risks, and the dearth of long-term data, gastric bypass surgery is one of the only proven methods for achieving rapid and significant weight loss. Which is why it's not surprising that teens are lining up to have the procedure. According to the American Obesity Association (AOA), about 15.5 percent of adolescents (ages 12-19) and 15.3 percent of children (ages 6-11) in the U.S. are obese. That's a dramatic rise since the late '70s, when the same numbers stood at 5 percent and 7 percent. And while experts argue over what's caused this alarming increase -- calorie-dense fast food? Increased TV watching? Reduction of physical education curriculum in schools? All of the above? -- many severely overweight adolescents just want a solution to their weight problems now.
