Obese Kids Going Under the Knife

Jan. 24, 2003 -- High blood pressure, diabetes, asthma, sleep apnea — these are all diseases that typically afflict adults. Today, a growing number of children are suffering from these ailments because of what some doctors are calling an epidemic among American kids — obesity.

The big after-school hangouts used to be playgrounds, where kids got a lot of physical activity. Today, kids spend their time in front of televisions or computers or hanging out at shopping malls. Throw fast food into the mix and this is what happens — a nation of overweight kids.

"This is an epidemic. This is the new plague," said Dr. Christine Ren, a gastric surgeon at New York University Medical Center.

"They're developing diabetes as children," she said. "There are children now with asthma, with high blood pressure. There are children with obstructive sleep apnea — they stop breathing in the middle of the night because fat tissue in the throat and the tongue is falling back over their windpipe."

A Drastic Solution?

The number of seriously overweight children in this country has tripled in the last 20 years. The situation is leading some parents and doctors to resort to drastic solutions to get them down to healthier sizes.

Gabby Ptasinski, 14, and her 16-year-old sister, Angie, have been obese — at least 50 pounds heavier than they should be — for years and are desperate to lose weight. Angie's highest weight was about 315 pounds. Gabby said her highest weight was about 280 pounds.

The sisters say their lives have been miserable because of their weight. "Just day-to-day life in school was a nightmare. You just prayed for the bell to ring," Angie said.

The feelings of sadness and isolation led the girls to eat more to cope with the pain.

"When I was full, and I had eaten as much as I could possibly eat, I felt like some part of me was full," said Angie. "Something that wasn't there, I guess — a friend who wasn't there; a teacher who wasn't there. You know, somebody just [to] tell you, you that you were pretty."

Angie said she and her sister have tried hard to lose weight but have always failed. Angie even spent a summer at a weight-loss camp. Over four years, she lost 50 pounds, but she can't seem to drop any more.

Angie's got plenty of company, which is why hospitals all over the country are setting up therapy groups so kids can try to help each other. But many of the truly obese, like 16-year-old Melissa Panei, are taking a bolder step.

Melissa once weighed nearly 300 pounds. For six months, she was on Meridia, the adult diet pill, and lost 65 pounds.

Other obese teens are turning to something many doctors find shocking — stomach-stapling surgery.

The surgery reduces the stomach to the size of a small pouch, or a band can be tightened around a portion of the stomach, so the patient feels full much more quickly while eating. And after the surgery, there's a strict diet.

Ren has performed gastric bypass surgery on more than 800 patients. She has begun performing the operation on teenagers — five so far — because, she says, sometimes it's the only option.

"I feel that I am saving their lives and I am preventing them from developing medical problems or at least treating their medical problems," she said.

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/