Aug. 15, 2007 -- The scene: A 12-year-old who is 5 feet, 5 inches tall and weighs 220 pounds undergoes liposuction to lose weight.
She then gets a tummy tuck. She diets off some weight, but then the weight comes back on — about half of what she'd lost altogether.
She gets worried and wants to have surgery so that she'll lose more weight. American doctors require "red tape," like testing for emotional readiness and medical conditions like sleep apnea. The family refuses, opting instead to take her to a surgeon in Mexico, who performs lap-banding surgery without all the tests required by the American docs.
First let me say that I'm glad that Brooke Bates is feeling better after all of this. I'm glad that she has lost some weight and that her health has improved.
I am not glad that she had liposuction. I'm also not glad that she went to Mexico to have a lap-banding surgery.
I can hear people saying, "Hey, lighten up, doc. She's thinner and happier." Let me explain my concerns.
First the liposuction. It's never been recommended for weight loss. It isn't effective.
This case proved that; Brooke soon began to gain weight after the procedure. Liposuction just removes localized deposits of fat. It's cosmetic surgery, period. It's what someone might consider after losing weight, who still has some fat bulges in unwanted places. You'll lose a few pounds, but it's mostly for appearance.
Lap banding, on the other hand, is done to facilitate weight loss.
Lap banding is a procedure in which a kind of strap is placed around the top of the stomach, preventing it from expanding, so that you get full by eating only small meals. Overeat, and you risk vomiting — and some people do.
The procedure is not benign, and significant problems and malfunctions of the banding can occur.
Most surgeons performing weight loss surgeries like this one require potential patients, regardless of age, to undergo psychological counseling and several medical evaluations in order to determine whether they are good candidates who can emotionally handle the process and its results — as well as to document serious acute conditions that might benefit from weight loss, such as sleep apnea.
Brooke's family declined to go through such procedures. Her mother has said in the past, "It's so much paperwork you have to go through. So much red tape is what I call it. I mean, they want you to get psychological testing. They want you to do, you know, get sleep apnea testing. And all those things I'm sure are very important, but it's just — it's money."
Sorry, but the surgery is where the money is spent. When a surgeon turns down a patient for lap-banding surgery, there's a reason, and it's called being responsible.
When parents override medical recommendations and travel to Mexico or another foreign country for the quick fix, it's a heck of a chance to take with a child's health.
It's good that things worked out for the Bates family, with no serious medical complications from the lap banding, but that doesn't mean the procedure is safe for a 12-year-old. It means that the Bates family may have dodged a bullet.
Surgery is not an "easy way out," but it is definitely the quick way, and that's not always the best way. To learn lifestyles that you'll stick to, slow and steady wins over fast and furious.
What concerns me most is that the real reason for the liposuction and the lap banding seems to be more related to cosmetics than health. Sure, she got healthier, but the primary reason was to look better.
The Real Problem
If a 12-year-old is about 200 pounds, then some seriously dysfunctional eating is going on, and it didn't start yesterday.
Neither liposuction nor gastric surgery will take care of that behavior in the long run. Consider how that kind of weight is achieved by a 12-year-old: The average infant weighs in at about 20 pounds by age 1. That leaves 180 pounds to be gained in 11 years — most of it likely was gained between ages 6 and 12 years.
Why would a child gain this much weight? It's not just a big appetite. It's not big bones. And it's not "glands."
Today, on "Good Morning America," Brooke's mother denied that Brooke's overweight was because of emotional eating. That seems hard to swallow, but if emotions aren't at least part of the picture, then Brooke grew up in an environment where she learned to overeat at a very young age and was allowed to continue doing so until things really got out of hand.
Brooke's body is now losing weight the same way everyone's body loses weight, by taking in fewer calories than her body needs. She could have done that before she went under the knife three times.
Brooke supposedly tried dieting in the past, but nothing worked. But she was only 12 years old. How many sustained efforts could there have been? How many changes were made in the home environment to help her?
Children who are overweight throughout their childhoods often learn poor eating habits and eat poor diets early on, so home is where the real changes need to happen. Sure, there may have been some dieting and exercise attempts while growing up, but to be effective such attempts require the participation of the whole family. No child can do it on her own, and everyone plays a role here.
Any child who is 12 years old and more than 200 pounds needed help at least 50 pounds ago.
Tips to Beat the Band
The good news — and there is lots of it — is that growing a healthy child really can be easier than it seems.
While I'm a nutritionist and have lots of science behind my recommendations, the truth is that with most healthy eating, one should just let common sense rule. Read on for a few habits that will make your life easier and your child healthier:
Start teaching a healthy eating style early. Nutrition has its best influence in the arena of prevention. If you're building a house, you want a strong foundation and to use the best materials. It's the same with building good eating habits.
Physical activity is a necessity — 60 minutes on most days is the goal. No need for a gym here, just age-appropriate play. Play with your children whenever you can. Your kids will learn that pleasures come from more than just food and leisure activity.
Screen time is not a necessity. Keep it to two hours per day, max.
You're a role model — make sure you're a good one. Your child will never eat a better diet than what they see you eating. Kids are sponges; they absorb everything they see. What you say make speak to them, but what you do will scream at them. Do wisely.
Sometimes, no is the right answer. Whether it's about food, TV time or anything else, kids need guidance and limits. If they didn't, they'd be able to raise themselves. They can't, but you can. Don't be afraid of a few rules.
Keith-Thomas Ayoob is an associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.