Adolescents and Weight Loss Surgery
Adolescent obesity is as alarming as obesity in adults. More than one-third of children and adolescents are overweight or obese.1 Similar to effects of obesity in adults, consequences of obesity in children and adolescents include:
- High cholesterol and other risk factors for heart disease
- Type 2 diabetes or poorly controlled blood sugar
- Osteoarthritis
- Sleep apnea
Obese adolescents are more likely to become obese adults and develop heart disease, type 2 diabetes and the other health conditions associated with obesity. Obesity adolescents face additional challenges.
- Higher risk for some kinds of cancer later in life.
- Social stigma
- Low self-esteem
- Poorer performance in school, possibly causing higher drop-out rates or less chance of finishing college and leading to lower income jobs
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Centers for Disease Control and Prevention. Childhood obesity facts. Web site.
http://www.cdc.gov/HealthyYouth/obesity/facts.htm. 2012, June 7. Accessed September 13, 2012.
Emotional Maturity and Support at Home
Adolescents are also still developing emotionally and cognitively. They need to have a great deal of psychological maturity and support from home to be successful controlling their weight after bariatric surgery. Adolescents considering bariatric surgery should meet the following criteria.
- Sufficient home support: encouragement from parents and siblings, family commitment to a lifestyle with healthy diet and exercise and agreement to keep healthy foods in the house and unhealthy foods out of the house
- Adequate emotional maturity: need to be strong enough to resist poor choices at school, possibly deal with social stigma from peers over the surgery and commit to long-term lifestyle changes
- Complete understanding and acceptance of the procedure and its risks, as well as the adolescent’s own role in weight loss
- Self-motivated to get bariatric surgery and supported, but not pressured, by parents
When Should Adolescents Consider Weight Loss Surgery?
Four percent of children and adolescents, or one out of every 25 adolescents, are extremely obese, with a BMI over 40.1 Weight loss surgery among adolescents aged 10 to 19 increased in the U.S. from 328 procedures in 2000 to 925 procedures in 2009, with the most procedures done among adolescents 17 years and older.2
Because bariatric surgery is such a life-changing event, the BMI eligibility criteria are different for adolescents than adults.3
- A BMI over 50.
- A BMI over 40 and a less serious comorbidity, or obesity-related condition such as high blood pressure, depression or high cholesterol.
- A BMI over 35 and a serious comorbidity, such as sleep apnea, type 2 diabetes, increased pressure within the skull or liver disease.
Adolescents are still developing physically. Surgeons should never perform bariatric surgery in adolescents if they think it will interfere with normal, healthy growth and development. Adolescents should at a minimum achieve peak height, which occurs around age 13 for girls and age 15 for boys, although different individuals have their own growth rates.
- Xanthakos SA. Bariatric surgery for extreme adolescent obesity: indications, outcomes and physiologic effects on the gut-brain axis. Pathophysiology. 2008;15(2):135-46.
- Kelleher DC, Merrill CT, Cottrell LT, Nadler EP, Burd RS. Recent National Trends in the Use of Adolescent Inpatient Bariatric Surgery: 2000 Through 2009. Arch Pedatr Adolesc Med, 2012;17:1-7.
- Nagle A, Zieve D. Weight-loss surgery and children. Web site.
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000356.htm. Updated 2011, July 1.
Which Weight Loss Surgery for Adolescents?
The Roux-en-Y gastric bypass has the longest history of use, and it appears to have good long-term weight loss results when it’s performed in good candidates. However, it carries a serious risk for nutritional deficiencies, such as iron (leading to anemia), vitamin B12 and calcium. Females in particular are at risk for osteopenia, or low bone mineral density, caused by inadequate nutrition. That puts them at higher risk for broken bones, or osteoporotic fractures, later in life. In addition, RYGB can lead to dumping syndrome when patients eat sugary or high-fat foods. This is likelier in adolescents who give in to peer pressure or whose home environments have these foods, and it can cause embarrassment and poor attendance at school.
The lap-band made up about one-third of weight loss surgeries in adolescents in 2009. A benefit for adolescents is that it’s reversible. In addition, it has a lower risk of nutritional deficiencies because it doesn't affect nutrient absorption. However, the lap-band is still experimental in adolescents. More research is needed on its long-term effects. The lap-band leads to more long-term complications, albeit somewhat minor, such as indigestion.
The gastric sleeve may be better for very high-BMI adolescents, just as it is for high-BMI adults, and it carries a lower risk of nutrient deficiencies than the gastric bypass because it does not interfere with nutrient absorption. However, it is an irreversible procedure, so it should only be used after careful consideration in adolescents, who are still developing and have many years of life ahead of them. Another drawback of the gastric sleeve is that it is still considered experimental in adolescents; not much is known about long-term results.
Other Guidelines for Adolescents
When possible, the procedure should be done in a bariatric hospital with healthcare team members who have special training in pediatrics or adolescent health. The team should include:
- A surgeon
- A pediatric specialist
- An experienced dietitian
- A mental health professional
- A care coordinator
- Adolescents need to be especially careful to get enough iron, vitamin B12 and calcium to prevent deficiencies. Osteopenia, or poor bone mineral density related to inadequate calcium or vitamin D, and thiamine or vitamin B1 deficiency are also threats.
Female adolescents should understand that they should not get pregnant within at least 18 months of having the surgery.