Obese Teens Face Slim Risks From Surgery

June 14, 2007 — -- Ashlee Kopp's early teenage years were miserable.

Weighing nearly 300 pounds at age 10, she felt trapped by her weight and the stigma it carried.

"I was really sad. I was never happy, and I came home from school crying daily," she said. "It was horrible."

She tried to slim down. But after three years of diets, a personal trainer and a dietitian, Kopp found herself at nearly the same weight as when she started.

"It wasn't helping," said her grandmother, Sharon Burnside. "Ashlee would lose a little, but then gain more."

Desperate for "a way out," Kopp looked to obesity surgery after seeing it on TV. "I wanted it so bad, but my grandma said, 'Let's research it first,'" she said.

While Burnside's concern was warranted, as bariatric procedures all involve surgery, a new study shows that obesity surgery appears as safe for teens as it is for adults.

University of Texas Southwestern's Dr. Esteban Varela and his colleagues found that 30 days after surgery, only about 5 percent of teens experienced complications -- a rate nearly half that seen in adults.

There were no adolescent deaths from the surgery, compared with one out of every 500 adults who died from complications due to their procedures.

Moreover, when the study authors focused on a subset of bariatric surgeries called restrictive procedures -- such as laparascopic gastric banding that decrease caloric intake by effectively decreasing the stomach's size -- the complication rate in teens went to zero.

The new study findings came from an examination of 309 adolescents and more than 55,000 adults who had obesity surgery at academic centers throughout the United States. The results are being presented today at the American Society of Bariatric Surgery meeting in San Diego.

"Based on these results, surgery seems safe," said Varela. "We can start thinking about offering it more to parents and adolescents as part of the treatment … for morbid obesity."

Relative Health

One reason why teens may face fewer complications than adults do is because they usually start out healthier.

"Adolescents have fewer medical problems," said Varela. "When adolescents do have medical problems, they have only been there for a few years."

But although obese teens may have fewer health problems than their adult counterparts, they do have more medical problems than their slimmer peers.

Teenager Kopp, for example, had high blood pressure, shortness of breath, frequent respiratory infections and borderline diabetes.

Obese teens may also face such problems as high cholesterol, arthritis, skin infections, sleep apnea, liver disease, imbalanced hormones, depression, anxiety -- not to mention social alienation.

The presence of obesity-related illness lowers the threshold for surgery. Bariatric surgery is usually offered to patients with a body mass index -- a commonly used ratio between weight and height -- of greater than 40. But when a patient has a medical condition caused by obesity, the body mass index threshold is reduced to 35-40, making surgery an option.

Problems Down the Road?

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While Varela's study showed less immediate complications for teens getting obesity surgery, it did not look at longer-term complications, including the possibility that such procedures could render teens' digestive systems incapable of absorbing the nutrition they need.

"We don't know what's really going to be the impact of malnutrition issues over time; we need long-term clinical trials," said Varela.

But Dr. Phillip Schauer, current president of the American Society for Bariatric Surgery, said current data on gastric bypass surgery suggest that, for these procedures at least, malnutrition may not pose a huge risk.

"What we've learned is that in general, the nutritional risk from gastric bypass is pretty low," said Schauer, adding that supplements can often help make up for nutrition deficiencies caused by the procedure.

Dr. Neil Hutcher, bariatric and general surgery faculty member at Medical College of Virginia, agreed, adding that growth and development have hardly been an issue in his patients.

"We know that female adolescents have achieved most of their sexual and growth maturity by age 14, and in males it's 15 to 16," he said.

Despite this, some pediatricians remain cautious.

"Bariatric surgery should be a last resort," said Dr. Chuck Wilson, a clinical professor of pediatrics at East Carolina University. "When a complication occurs, it is for the lifetime of the child."

Reversible Risk

Kopp was not too concerned about any longer-term complications because she ultimately chose laparascopic gastric banding, a reversible procedure in which a band is placed around the entrance to the stomach.

"If there were any complications it could just come out," she said.

Indeed, many physicians are only recommending gastric bands for obese teens seeking surgery.

"We only offer the gastric band due to the significant safety as compared to gastric bypass, both surgical and nutritional," said Dr. Christine Ren, a bariatric surgeon at New York University.

But Schauer notes that while the band is attractive due to its lower risk and reversibility, it does not lead to as much weight loss as gastric bypass procedures, which are riskier and less reversible.

"One has to balance the reduced risk of the band compared to the enhanced weight loss with gastric bypass," he said.

Surgery for Some

Kopp lost nearly half her body weight with the gastric band. At 5 feet 10 inches, she now weighs 150 pounds -- and she has had no complications since her surgery four years ago.

"It changed everything around," she said. "Everything is good now. I'm dating. I'm going to college next year. I'm more self-confident, and I'm a happier person altogether."

But doctors warn that while surgery worked for Kopp, it's not for every teenager, even if the new study shows low complication rates.

"I think it's important that surgery is not for every teenager, certainly not for teens with a small amount of weight to lose," said Schauer. "For teens suffering from severe obesity who have failed other weight-loss methods, surgery can be very effective and help them restore themselves to good health."

Madelyn Fernstrom, founder and director of the University of Pittsburgh Medical Center weight management center, agreed. She added that teens and parents who are thinking about surgery should choose a center carefully.

"I believe that only centers that provide comprehensive preoperative and postoperative support should be doing these operations," she said. "Nutritional, exercise, behavioral, and medical issues all need to be part of this treatment."

While Varela's study showed less immediate complications for teens getting obesity surgery, it did not look at longer-term complications, including the possibility that such procedures could render teens' digestive systems incapable of absorbing the nutrition they need.

"We don't know what's really going to be the impact of malnutrition issues over time; we need long-term clinical trials," said Varela.

But Dr. Phillip Schauer, current president of the American Society for Bariatric Surgery, said current data on gastric bypass surgery suggest that, for these procedures at least, malnutrition may not pose a huge risk.

"What we've learned is that in general, the nutritional risk from gastric bypass is pretty low," said Schauer, adding that supplements can often help make up for nutrition deficiencies caused by the procedure.

Dr. Neil Hutcher, bariatric and general surgery faculty member at Medical College of Virginia, agreed, adding that growth and development have hardly been an issue in his patients.

"We know that female adolescents have achieved most of their sexual and growth maturity by age 14, and in males it's 15 to 16," he said.

Despite this, some pediatricians remain cautious.

"Bariatric surgery should be a last resort," said Dr. Chuck Wilson, a clinical professor of pediatrics at East Carolina University. "When a complication occurs, it is for the lifetime of the child."

Reversible Risk

Kopp was not too concerned about any longer-term complications because she ultimately chose laparascopic gastric banding, a reversible procedure in which a band is placed around the entrance to the stomach.

"If there were any complications it could just come out," she said.

Indeed, many physicians are only recommending gastric bands for obese teens seeking surgery.

"We only offer the gastric band due to the significant safety as compared to gastric bypass, both surgical and nutritional," said Dr. Christine Ren, a bariatric surgeon at New York University.

But Schauer notes that while the band is attractive due to its lower risk and reversibility, it does not lead to as much weight loss as gastric bypass procedures, which are riskier and less reversible.

"One has to balance the reduced risk of the band compared to the enhanced weight loss with gastric bypass," he said.

Surgery for Some

Kopp lost nearly half her body weight with the gastric band. At 5 feet 10 inches, she now weighs 150 pounds -- and she has had no complications since her surgery four years ago.

"It changed everything around," she said. "Everything is good now. I'm dating. I'm going to college next year. I'm more self-confident, and I'm a happier person altogether."

But doctors warn that while surgery worked for Kopp, it's not for every teenager, even if the new study shows low complication rates.

"I think it's important that surgery is not for every teenager, certainly not for teens with a small amount of weight to lose," said Schauer. "For teens suffering from severe obesity who have failed other weight-loss methods, surgery can be very effective and help them restore themselves to good health."

Madelyn Fernstrom, founder and director of the University of Pittsburgh Medical Center weight management center, agreed. She added that teens and parents who are thinking about surgery should choose a center carefully.

"I believe that only centers that provide comprehensive preoperative and postoperative support should be doing these operations," she said. "Nutritional, exercise, behavioral, and medical issues all need to be part of this treatment."

"I believe that only centers that provide comprehensive preoperative and postoperative support should be doing these operations," she said. "Nutritional, exercise, behavioral, and medical issues all need to be part of this treatment."