Teens and Weight Loss Surgery
Dr. Owens, Medical Director at Coastal Center for Obesity, answers questions
regarding teens and weight loss surgery.
Question: Is gastric bypass surgery safe for a teenager?
Dr. Owens response: The data in the medical literature shows that weight loss
surgery is as safe in teenagers as it is in adults.
Question: When should teenagers consider gastric bypass as an option?
Dr. Owens response: Generally when they are in the top five percentile with
regards to weight or roughly twice normal body weight. Less heavy teenagers
with serious complications of obesity might be surgical candidates also.
Although there is little evidence that significant weight loss can be achieved
and maintained without surgery, teens considering surgery should have made at
least one serious effort to lose weight without surgery. Also they should be
willing to make a similar serious effort after surgery as surgery alone does
not guarantee good long-term weight loss.
Question: What's a thumbnail description of the surgery?
Dr. Owens response: Gastric bypass is not the only effective operation to
produce weight loss but it is the gold standard in the US. Laparoscopic
adjustable banding has been done successfully on teenagers in Australia and is
being adopted as a weight loss treatment in the United States. Unlike gastric
bypass it does not alter the internal anatomy although it may be somewhat less
effective in producing weight loss. Both procedures reduce the reservoir
capacity of the stomach from about 2 qts to about ½ an oz, or 2 liters to 15
cc. In both procedures a small food-holding pouch is created from the very top
portion of the stomach.
Question: Are teenagers more of a risk than adults, and if so, why?
Dr. Owens response: The concern with doing surgery on children and adolescents
relates to interfering with normal development or setting the stage for long
term side effects. Although the available information leaves some
uncertainties, surgery for weight loss in severly obese teenagers is clearly
preferable to no or inadequate weight loss. In addition to the dangerous
medical effects of obesity, obese teenagers are stigmatized by their peers more
severely than adults and suffer long term psychosocial effects. Hence, the
longer term potential for undesirable side effects from surgery must be weighed
against the emotional damages a teenager suffers from being severly obese.
Question: What are the risks - physically and emotionally?
Dr. Owens response: By and large the emotional risks of obesity are impaired
self-esteem and depression. Suicide in teenagers is an important cause of
death, although I am not aware whether it has been related to obesity or not.
Question: How can someone lose such a great amount of weight so quickly without
changing their personality drastically?
Dr. Owens response: What we see in the first month after surgery is fair amount
of ‘buyer’s remorse. After that patients are almost uniformly euphoric as they
make progress in treating a disease they have suffered for years. A rare
patient for whom food was their ‘only friend’ may become severely depressed. In
approximately 2000 patients we have seen 3 or 4 suicides, perhaps half of which
were related to the weight loss surgery. Many patients report difficulty
thinking of themselves as thin even many months after successful surgery. Very
few report significant difficulties adjusting to weight loss, although being
rejected by still overweight friends is a common experience.
Question: How does the surgery alter a teenager's future?
Dr. Owens response: We believe that it reduces emotional suffering, improves
socialization and improves the likelihood of a long healthy life.
Question: Can a teen still have children and go on to lead a normal adult life
after this surgery?
Dr. Owens response: Yes. Losing weight improves fertility and decreases the
likelihood of problems with labor and delivery.
Question: Do you have any statistics on how many teenagers are overweight, and
how many have had gastric bypass surgery?
Dr. Owens response: More than half of teenagers are overweight and more than
25% meet criteria (greater than 95th percentile) for obesity. The
number who have had weight loss surgery is unknown but there are several
publications in the medical literature supporting the safety and effectiveness
of weight loss surgery in teenagers.
Question: Are the long-term effects of this surgery known? If so, what are they,
and if not, why would you still recommend this as an option?
Dr. Owens response: All abdominal operations produce some long term risks but
in general they are relatively minor or rare. There are a fairly large number
of patients who are close to twenty years after gastric bypass and they seem
not be having any particular problems. Iron, vitamin B12, and calcium
deficiencies can occur after gastric bypass but are usually easily avoided with
Question: What is your response to critics who say that this option is an "easy
way out" or that teenagers aren't mature enough to make this life-changing
Dr. Owens response: Under the best of circumstances weight loss surgery is
painful and moderately dangerous. To undertake surgery takes courage and a
willingness to make changes and to be truly successful it takes a
sustainedeffort afterwards. For the very obese there is no ‘easy way out’ and
that there is any way out at all is to most of them very good news.