Teen Weight Loss Surgery: How Young Is Too Young?

Raechel Arnold, 17, lost an astounding 117 pounds just five months after undergoing gastric bypass surgery. Seventeen-year-old Amanda Munson's diabetes went into remission after losing 40 pounds as a result of surgery. Amanda Baron shared her story of going from a size 20 to a size 12 after bariatric surgery with The Today Show. Clearly, weight loss surgery is changing lives. But what are the long-term effects of operating on teens? How young is too young?

As the childhood obesity epidemic rages on, the number of bariatric surgeries performed on adolescents increases each year. Research published in the Archives of Pediatrics & Adolescent Medicine suggests that the number of teen weight loss surgeries has tripled in recent years. Ten years ago, the National Institutes of Health recommended against the procedure in children and teens, in part because the operations themselves were risky, with a death rate of about 1 in 50. But with obesity on the rise among 6- to 19-year-olds and ever-improving technologies, many doctors have begun approving the surgery for certain groups of young people.

Bariatric surgery involves the reduction in size or restriction of the stomach in order to reduce the amount of food a person consumes. The two most common bariatric procedures for adolescents in the U.S. are the gastric bypass and the adjustable gastric band. Both operations are typically performed laparoscopically.

Although experts debate whether the procedures are appropriate for teens, one fact is clear: Bariatric surgery is only for the very obese. Most doctors determine teen eligibility using the criteria for adults set by the National Institutes of Health, which indicates bariatric surgery for a person with a body mass index (BMI) of 40 or more, which is about 100 pounds overweight, or a BMI between 35 and 39.9 along with a serious obesity-related health problem like type-2 diabetes.

Surgery is generally warranted only when adolescents have tried and failed in organized weight loss attempts for at least six months, often under the care of a doctor. In addition, teens must agree to not become pregnant for at least a year after surgery. Candidates for surgery should be old enough to have attained a majority of skeletal maturity (which generally translates to 13 years of age for girls and 15 years of age for boys). Many surgeons also evaluate the candidates' emotional maturity, requiring that they understand and agree to the necessary lifestyle changes and have the support of family members.

The Benefits of Weight Loss Surgery

Proponents of weight loss surgery in teens argue that obese children have a 70 to 80 percent chance of growing into obese adults. With life-threatening risks like type-2 diabetes, heart disease, high blood pressure, and sleep apnea, many doctors believe that in extreme cases, the dangers of growing up obese outweigh the risks of surgery.

A survey in the Journal of the American Medical Association showed obese children rate their quality of life as low as young cancer patients undergoing chemotherapy. In addition to developing serious diseases, obese children and teens commonly face emotional trauma from being socially ostracized, teased, and unable to participate in regular activities.

Dozens of success stories suggest that for some, weight loss surgery is the only answer. Many teens tout the benefits of getting a fresh start, being able to move more freely and exercise, and feeling self-confident and assured for the first time in their lives. Research shows that bariatric surgery can indeed improve a person's lifestyle and health. Patients who follow doctor's orders can lose 5 to 15 percent of their total body weight within the first month following gastric bypass surgery, and many lose up to 60 to 70 percent of their weight within a year.

Conditions like diabetes, hypertension, coronary artery disease, gout, and sleep apnea often diminish substantially or are cured as a result of the weight loss. For example, a new study shows that extremely obese people who had weight loss surgery had less than half the risk of heart disease following surgery and were also less likely to require heart surgery to unclog blocked arteries than those who did not have the surgery.

Some doctors argue that bariatric surgery is actually safer for young people than adults because they haven't developed obesity-related problems like high blood pressure and heart disease, which increase the risks of surgery. Also, statistics suggest teens heal faster and have shorter hospital stays and fewer in-hospital deaths than adults.

With all of these benefits and the promise of a brighter future, more and more teens are considering bariatric surgery as the answer to their weight issues. But the downside of surgery is causing experts to take a closer look.

Weighing the Risks

Weight loss surgery is a major operation with lasting effects. According to the Agency for Healthcare Research and Quality, four in 10 adult weight loss surgery patients develop complications within six months. Common complications include vomiting, internal hemorrhaging, wound problems, pouch stretching, band erosion, leakage of stomach contents into the abdomen, nutritional deficiencies, and dumping syndrome (which resembles a severe case of influenza, brought on by the intake of sugar).

A report in Pediatrics warns that the long-term effects of gastric bypass on adolescents are unknown. Chronic nutritional deficiencies could affect teens' learning ability, sexual development and fertility, and digestive health. Most experts agree the surgery can stunt the patient's height. Researchers also are concerned that the surgery might prevent children from absorbing enough calcium at the critical age when peak bone mass occurs (ages 15 to 17). Among adult patients, 30 percent suffer from nutritional deficiencies such as anemia or osteoporosis because their bodies aren't absorbing enough vitamins and minerals. Since adolescents are notorious for ignoring doctor's instructions and failing to take medications, critics question whether or not teens can commit to a strict regimen that may include daily vitamins or shots for the rest of their lives.

In addition, an average of one in every 200 gastric-bypass patients dies. Laparoscopic gastric banding is a simpler, reversible operation, and has been shown to have a much lower death rate - about 1 in 1,000 patients - but complications like hernias, slipping bands, hair loss, and vitamin deficiencies do occur.

Within the first year after surgery, most gastric bypass patients lose a significant amount of weight. However, after the first year, weight loss levels off and many patients are still overweight, with more dieting and exercise needed to achieve a healthy BMI. What's worse, some patients gain back 10 to 20 percent of the lost weight within three to five years. According to the National Institutes of Health, weight loss surgery has a 40% complication rate and a 50% weight regain rate.

Obesity has a number of causes, from genetics and a sedentary lifestyle to a high-calorie diet and emotional issues. Since emotional or psychological factors often play a significant role in weight gain, treating obesity with a surgery that addresses a physical condition will not necessarily resolve the underlying cause of the problem. After losing a large amount of weight in a short time, it can be difficult for teens to understand that weight loss is a lifetime commitment. Without addressing the emotional undercurrents of overweight and obesity, a permanent change in habits is unlikely.

In order to be successful, weight loss surgery must be the first step in a long journey to better health. The patient must make permanent changes to his diet and exercise regimen in order to sustain the weight loss. Immediately after the surgery, the patient must maintain a highly restrictive diet, at first consuming only liquids, then only pureed food, and finally very small portions of healthy foods like a couple of grapes or a few bites of lean chicken breast. If a patient refuses to follow the strict diet, the digestive tract can expand and the patient can regain all of the weight, and more. At a cost of $20,000 to $50,000, weight loss surgery isn't a procedure that should be repeated if the weight comes back.

Given all of these risks, surgeons do a thorough evaluation of every candidate before agreeing to perform weight loss surgery. The long list of unknowns makes many experts uncomfortable with the idea of more teens turning to surgery. Dr. Diana Farmer from UCSF Children's Hospital believes that since kids are not dying from obesity at or before age 18, they should delay surgery until they become adults, rather than having their parents decide for them. The International Size Acceptance Association discourages the practice of performing weight loss surgery on teens and pre-teens, and instead advises kids to become involved in physical activities, eat fewer fast foods, and reduce the time they spend in front of the television and computer. A number of studies are ongoing to determine whether surgery is a positive long-term solution for obese teens.

The immediate benefits of weight loss surgery make it an appealing option for many obese teens. But what complications could arise as the teen enters mid-life and beyond? The answers still aren't clear. The only fact experts agree on is that weight loss surgery should be a measure of last resort. The goal should always be weight loss through a healthy diet and exercise, without surgery. With all of the unanswered questions and potential long-term effects, children and teens should try every alternative, including weight loss camp  and healthy living programs, before looking to a surgical "quick fix."