"We only do the operation in kids that have a BMI [body mass index, a measurement of obesity] over 40, rarely over 35 with a serious comorbidity," Wulkan said, explaining that a comorbidity is a complication of obesity such as high blood pressure or diabetes.
"One of the reasons we do this in kids is there's growing evidence that the earlier you intervene, the more successful you'll be at decreasing those comorbidities and preventing them," he said. "It's much easier to take a kid who has pre-diabetes or very early diabetes and reverse it with bariatric surgery than it is to take an adult who's had it for 10 or 20 years and then try to reverse it."
Dr. John Morton, director of Bariatric Surgery at California's Stanford School of Medicine, has performed 2,000 laparoscopic banding procedures in adults, 50 of which he said were in young adults. He described the difference this surgery has made in the lives of those he has treated as "a huge deal."
"People often say that [surgery's] the easy way out," Morton said. "In fact, it's the hard way in. All these kids have been at it for almost a decade before they come to us. They've all tried to lose weight. They all want to lose the weight, none of them want to be that way."
But benefits are only one side of the issue. Wulkan said the benefits of the procedure must be balanced against the possible long-term consequences for young patients who will be living with these results for decades longer than their adult counterparts.
"The biggest risk is that it's got to last a lifetime; the procedure that you do has got to be something that's going to serve this child all the way through adulthood and hopefully old age," Wulkan said. "So the potential for complications along the way are greater."
Dr. D. Wayne Overby, assistant professor of Surgery at the University of North Carolina School of Medicine in Chapel Hill, said the laparoscopic banding procedures may indeed be a solution for some young patients for whom other methods of weight control have not worked. But he, too, noted that more must be known about the effects of this procedure in younger patients.
"Further studies need to be done to more exactly define the indications for surgery, which patients are the most appropriate candidates, as well as which procedures best balance risks and benefits," Overby said.
Potential side effects of the surgery aside, experts in adolescent obesity said the most worrying aspect of the research involves its implications for the increase of weight problems in the young.
"I find the trend documented in this paper to be terribly troubling," said Russell Pate, associate dean for research at the University of South Carolina in Columbia. "Of course, it is very sad that there are significant numbers of adolescents who are considered to be candidates for bariatric surgery. Beyond that, I am not all convinced that we are doing the research that will be needed to determine to which patients this procedure should be administered.
"There are no good treatments for established, severe obesity. In my view, prevention is the only approach that makes sense."
Yet, some patients who have undergone bariatric surgery say these procedures have served as a bridge to this healthier lifestyle -- an approach that surgeons who perform these operations support.