How Young is Too Young for Bariatric Surgery?

June 13, 2012— -- A gastric sleeve operation helped Betsy Sanchez, of Coahuila, Mexico, lose nearly 70 pounds, reports the Daily Mail. She's only 12. Her case is becoming increasingly familiar as doctors perform bariatric surgery on younger adolescents and children.

Before her operation, Betsy weighed 210 pounds and had a body mass index of 41, the paper says. Her mother, Ana Sanchez, said she tried to cut portion sizes for her daughter as she grew heavier, but Betsy would demand seconds and throw tantrums if she didn't get snacks.

"Diet and exercise didn't work for Betsy. She was addicted to food, only surgery would work," Sanchez told the Daily Mail.

Dr. Guillermo Alvarez, a bariatric surgeon in Piedras Negras, Mexico who was also Sanchez's second cousin, performed Betsy's surgery.

"It is very controversial to operate on children," Alvarez told the Daily Mail. "But I see the benefits of helping children in cases where parents have tried everything but nothing else seems to control their eating problem."

Now 14, Betsy said she has taken up exercising and is no longer bullied for her size.

"It has changed Betsy's life," Alvarez said.

A twelve-year-old may seem young for a grown-up surgical procedure, but such operations are happening more and more. As bariatric surgeries become more common in teens and adolescents, doctors have been debating the earliest age at which they should be performed. Some surgeons in other countries have started doing the procedure on even younger children; in April, doctors in Saudi Arabia reported performing surgery on children as young as 5.

Doctors in the U.S. are also performing gastric sleeve and other bariatric surgeries on children, in hope of arresting obesity and a host of related diseases that plague 17 percent of children and teens in the U.S. But many are divided on how young is too young for the procedure.

"I think 12 is too young," said Dr. Elizabeth Prout Parks, a pediatric gastroenterologist at the Children's Hospital of Philadelphia. "The reason is that cognitively, you need to make sure they understand this is a life-changing event that they can't ever reverse."

Gastric sleeve surgery, called a sleeve gastrectomy, involves shrinking the stomach from the size of a football to the size of a banana. But unlike other types of bariatric surgery, such as gastric bypasses, it doesn't keep the body from absorbing key nutrients. That makes it a more attractive option for children and adolescents, who still have some growing to do.

"The sleeve doesn't have as many of the complications that you see with other types of bariatric surgery," such as vitamin and nutrient deficiencies, said Dr. Amir Mehran, director of the UCLA Metabolic and Bariatric Surgery Program. "If you decide to do bariatric surgery in kids, that's the way to go."

But Mehran said he'd still hesitate to do the operation on any child younger than 15.

Recent research seems to be on bariatric surgery's side. Studies have shown that the procedure goes a long way, not just in helping obese patients lose weight, but also in reducing diabetes, high blood pressure, sleep apnea and other conditions that go along with excessive weight.

Dr. Phil Schauer, director of the Bariatric and Metabolic Institute at the Cleveland Clinic, has performed the sleeve gastrectomy on a child as young as 12. He said the benefits justify performing it in a younger teen instead of waiting until they are older.

"The problem with waiting until the child is 18 or 20 is that in those six to eight years of waiting, their diseases could worsen and you could be in a lot worse shape," Schauer said.

U.S. medical centers that perform the procedure say they follow stringent guidelines in selecting the right candidates for the operation. The children who get it are usually extremely obese, with BMIs in the 40s and 50s (obesity is above 25), and face other conditions like diabetes. They also spend many months in a weight control program, trying to shed pounds through diet and exercise.

"If, after a reasonable attempt has been made to lose weight with more conservative strategies and that doesn't work, then the next logical step is surgery," Schauer said.

Children also get a psychological evaluation to determine if they are mature enough to handle the surgery and what it will mean for the rest of their lives.

Dr. Marc Michalsky, surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, said although the risks must always be taken into account, the benefits of the surgery for younger teens are pretty compelling.

"If nothing is done with the typical child, they really have a very bleak future to look forward to in terms of the types of cumulative damage that obesity will have on their body. I think is the foundation of why these operations are becoming more popular in the adolescent population," he said.