Obesity Surgery for Weight Loss: A New Teenage Trend?

Bariatric procedures in teens appear to be on the rise. How young is too young?

ByDAN CHILDS, ABC News Medical Unit
September 18, 2010, 3:31 PM

Sept. 20, 2010— -- It's an option that may seem extreme for a teenage patient. But ask 15-year-old Kallum Shropshire, who just earlier this year weighed more than 400 pounds, and he will say that obesity surgery was his last resort.

"I've tried dieting and Slim Fast, and other fitness programs too," Shropshire said. "It was just a bunch of work that didn't really pay off."

The LaFayette, Ga., teen said his obesity posed problems beyond the implications for his physical health. Two years ago, he said, his weight interfered with his participation in marching band; eventually, he had to drop out.

"The risk of surgery didn't really matter to me because I really needed something done," he said. "Because I wasn't me, I couldn't really be myself in front of everybody. I just felt like I was an outcast."

For Shropshire, the solution was bariatric surgery in the form of a gastric sleeve operation -- a procedure that removes roughly 85 percent of the stomach. Since his surgery on June 3, Shropshire said he has lost 60 pounds. That was enough weight loss to allow him to complete marching band camp this year. And he hopes that more results are on the way.

"I'd like to lose at least 110 more pounds," he said. "That's my goal is to get down to 250."

Stories like Shropshire's may be becoming increasingly common, a new study released today in the journal Pediatrics suggests. The research, led by Dr. Daniel A. DeUgarte of the UCLA School of Medicine, found that between 2005 and 2007 in California, a total of 590 young patients 13-20 years old underwent a popular type of bariatric surgery known as laparoscopic adjustable gastric banding, or LAGB.

Perhaps more interesting: over the course of the two-year study, rates of the procedure in this age group increased fivefold.

Most of these procedures occurred in patients on the older end of the age spectrum; only 18 percent of the surgeries were performed on children younger than 18. And while the rates of this surgery appear to be on the rise in younger patients, the rates of another, more invasive gastric procedure known as Roux-en-Y gastric bypass decreased in this age group over the course of the study.

Gastric Procedures in Teens: Weapon Against Obesity Epidemic?

Still, the findings may have big implications in a country in which nearly one in five adolescents aged 12-19 are obese, according to statistics from the Centers for Disease Control and Prevention. Bariatric surgery has become a popular option among obese adults; more than 220,000 obese Americans underwent such procedures in 2009.

The Food and Drug Administration, however, has not yet specifically approved the safety of these procedures for children.

"Although LAGB has not been approved by the U.S. Food and Drug Administration for use in children, its use has increased dramatically," the authors wrote in the study. "Long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents."

Dr. Mark Wulkan, Surgeon-in-Chief at Children's Healthcare of Atlanta and Associate Professor of Pediatrics at Emory University School of Medicine, who performed Shropshire's procedure, said due to this, doctors should be very careful when selecting young patients for the procedure.

"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."

Balancing Benefits and Risks of Obesity Surgery in Teens

"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."

Gastric Procedures in Teens: A Second Chance?

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.

"Bariatric surgery is not a cure but rather a tool to give a patient another chance at a lifetime of healthy living, diet and exercise," said Dr. Scott Belsley, director of Robotic Surgery at St. Luke's-Roosevelt Hospital in New York.

Shropshire said this second chance has changed his life.

"People who hadn't talked to me over the summer, they noticed a big change in me," he said. "They noticed my personality coming out, me being more bright and outgoing and stuff. And I can do more with everybody, like go out and have fun."

Web-Extra Tips

Dr. Richard Besser, ABC News' senior health and medical editor, appeared on "Good Morning America" today to talk about the issue. He gave some tips for how you can help your teens remain at a healthy weight.

ABC News' Katie Moisse contributed to this report.