In these cases of extreme obesity, Ren said, children need more than just diet and exercise to help them. "When you're talking about 50, 60 pounds for a child, that's like an adult trying to lose 100 pounds. You're more likely to survive a malignant brain tumor than to lose 25 pounds and keep it off for five years," she said.
Ren stressed that she views the surgery as a lifesaving measure, not simply a weight-loss strategy. "They're at risk, a very high risk of becoming a morbidly obese adult, which then increases their risk of death by 12 times," she said.
In the case of Angie and Gabby, their weight problems mirror those of their mother. Their mom, Lucy, is herself dangerously overweight, after years of failing in attempts to diet and exercise. She agrees that surgery is the only solution left for her girls.
No ‘Free Ride’
Some 300 miles away, in Richmond, Va., another teenager has decided to undergo the surgery. At age 17, LaShanna Johnson is 5 feet 9 inches tall and weighs 324 pounds. She says her knees ache and she can't sleep. Despite good grades, she dropped out of high school because of the constant teasing about her weight.
LaShanna's surgeon, Dr. Harvey Sugerman of the Medical College of Virginia, has written a number of reports on gastric bypass surgery and has just completed one of the few done on adolescents. It says the surgery is safe for them, too, though he admits there are some risks.
"There's a risk of death with the surgery. There are risks of leaks and other complications that can occur, the risk of wound infection," Sugerman said.
Sugerman said he performs the surgery only on adolescents who have serious medical problems. Like other surgeons, Sugerman insists that his young patients be evaluated by psychologists to gauge their maturity.
"We tell our patients that this isn't a free ride. That they have their responsibility to make this operation a success as we do," he said.
Weighing the Risks and Results
But with little research on whether these adult treatments are safe for children, some government officials are worried.
"We know that obesity results in Type II diabetes, heart disease, high blood pressure, cancer. We have to do something about it. But in my view, surgery is an extreme strategy. Teenagers are being asked to make a decision which affects them for the rest of their lives," said Dr. William Dietz, director of nutrition at the Centers for Disease Control and Prevention.
Dietz is also reluctant to endorse the use of diet drugs. "They should not be used routinely for the treatment of obesity," he said, adding, "We know [in] pediatric patients that often the response to drugs is quite different than it is among adults."
Dietz also said people who use pills for weight loss usually don't manage to keep the weight off.
Still, teenagers all over the country are willing to take the risk. Melissa Panei, who took Meridia, appears to be doing well. And as for the stomach surgery on kids, there've been two deaths reported in the literature, but the teenagers we met are all doing well.
Angie has lost 41 pounds and Gabby has lost 53 since their surgeries in October. LaShanna has lost 60 pounds in 2 ½ months. So far, none of them has had complications. Their success is further evidence for doctors who believe that the controversial treatment, even with the risk, is well worth it.
"They're losing weight and they're keeping it off," said Ren. "Their medical problems go away. They're happy and their parents are happy. And I have absolutely no fear that this is the wrong thing to do."
For more information about obesity, and about gastric bypass surgery, visit the following Web sites: http://www.obesityhelp.com http://www.cdc.gov/nccdphp/dnpa/obesity/