Weight loss surgery for children and teens struggling with obesity

Right now, one in 12 children and adolescents in the US are severely obese. If that isn't startling enough, consider this: among 12-to-15-year-olds, that number jumps to one in 10 — and among 16-to-19-year-olds, it is one in seven. According to the American Academy of Pediatrics (AAP), the best hope for many of these youths may be bariatric surgery. Bariatric surgery is surgery that helps with weight loss by making the stomach smaller and making other changes in the digestive system.

It's jarring to think about doing irreversible surgery on an adolescent — or a child, as the AAP discourages age limits for bariatric surgery. But the reality is that obesity, with all of its risks, can be equally irreversible.

In children and teenagers, obesity is defined as a body mass index (BMI) greater than or equal to the 95th percentile for age and sex. If you are obese by the time you are 12, research suggests you have a 98% chance of being obese as an adult. Those are not good odds — and they are made more alarming by the complications of obesity. Diabetes, high blood pressure, fatty liver disease, and obstructive sleep apnea (which can lead to further problems, including heart disease) are the most common complications among younger people. In adults, the list expands to include even more problems, such as stroke, arthritis, and cancer.

Clearly, this is not a problem we can ignore.

When obesity isn't severe, lifestyle changes such as eating a healthy diet and getting more exercise are absolutely the go-to methods of care. But once you get into severe obesity — usually a BMI of 35 or higher — lifestyle changes just don't do the trick. (Severe obesity is a BMI greater than or equal to 120% of the 95th percentile for age and sex.) If lifestyle changes are all we suggest for children with severe obesity, we are condemning them to obesity and all of its complications. It's that simple.

What does research on bariatric surgery tell us?

In the longest study of the effectiveness of bariatric surgery in youths, which followed patients for eight years on average, those that had surgery lowered their BMI by 29%. Those that didn't have surgery? Their BMI went up by an average of 3.3 points.

Of course, the idea of surgery raises concerns. Yet bariatric surgery is actually safe and effective if done by experienced surgeons working in a high-quality center, with a strong multidisciplinary team that can give patients and families the ongoing education and support they will need, including psychological support. Surgical complications are infrequent and usually minor. The most common complication is micronutrient deficiencies, such as iron deficiency. While these can be prevented by taking supplements regularly, the reality is that adolescents are not always great about taking anything regularly. That's why it's important that the surgery be done at a center that offers a team approach and follow-up care in years to come.

Which children might benefit from weight loss surgery?

According to the AAP, parents and pediatricians can consider bariatric surgery if a child or teen

• has a BMI greater than or equal to 35 and one or more complications of obesity
• has a BMI greater than or equal to 40 whether or not they have complications.

Not everyone who falls into those groups should have surgery, though. It is not recommended for youths who

• have untreated or poorly controlled substance abuse problems
• have eating disorders
• are pregnant or planning pregnancy.

It is also not recommended for those who can't follow all the post-operative recommendations, including all the lifestyle and eating changes that are mandatory after surgery. Anyone who has had bariatric surgery needs to be very careful and thoughtful about what they eat, not just in the weeks and months after surgery, but for the rest of their lives. They'll also need to take supplements every day.

The bottom line

While bariatric surgery is clearly not a decision to be taken lightly, it's not a decision we should be avoiding, either. If we want to give severely obese youth their best chance of a healthy life, we have to get over our fear of surgery — and the common bias that obesity is just a matter of personal responsibility (think willpower) and not the medical problem that it is. Our children deserve better.