Obesity → Gastric Bypass for Morbid Obesity in Teens
Life Changing Surgery at the Start of Life
One of the areas that remains controversial in Bariatric Surgery is surgery on the adolescent patient. In this section we will re-state our opinion on this issue as we feel quite strongly about offering the right care to this relatively underserved group of individuals. We must also state that with the national trends being what they are, this group of morbidly obese individuals may increase in numbers, unfortunately. When we are speaking of surgery on children we are talking about individuals who are 13 to 18 years of age. We will re-state our opinion early in this document so it is clear to the reader; we support bariatric surgery in the adolescent (with some specific restrictions).
First of all it must be understood that these are kids who are suffering from a chronic disease and they are not likely to “trim down with their next growth spurt”. The data shows that if one parent is morbidly obese the morbidly obese adolescent has more than a 50% chance of being morbidly obese into adulthood. If both parents are morbidly obese the chances go up to about 80%. Obesity makes the development happen earlier so most obese girls at 12 or 13 have reached maturity and most boys at 14 or 15. These are children who suffer! They suffer physically, physiologically, emotionally and socially.
So what are the “rules” about operating on morbidly obese adolescents? We would also refer you to a journal article and the invited commentary. We believe the criteria for children ages 13 to 18 should be essentially the same as for their adult counterparts with a few exceptions.
- Psychological evaluation pre-operatively is mandatory and needs to be done by someone involved in the bariatric program so they fully understand the issues at hand.
- The family needs to be involved in the pre-operative psychological evaluation as well.
- There needs to be more pre-operative “contact” between the patient and the family and the surgeon.
- The surgical program needs to be very well established and have an excellent track record to better insure the safety to the adolescent patient. Complications can happen in any patient but one can mitigate the risk, somewhat, with experience.
- Surgery needs to be done where they are comfortable caring for the patient. It sounds quite simple but with this population it may not be so simple. Should the operation be done in a children’s hospital or in an “adult” facility? Remember these are individuals who are more the size of adults, to be sure, and many children’s hospitals are not used to “large kids”. It would be preferable to have the adolescent cared for in a knowing, post bariatric, surgical unit whose nurses have been trained to have empathy for the morbidly obese teenager.
With the above in mind, let’s talk a little about the family and the interaction with the patient. It is very important that the decision for surgery be that of the patient and not the parent’s. Clearly there needs to be support and acceptance by the parents but the reason for surgery needs to be within the patient.
At this point you might wonder if Wittgrove Bariatric Center performs surgery on adolescent patients or not. We certainly have and continue to do so. In fact Dr. Wittgrove helped train the surgeons at Cincinnati Children’s Hospital. Dr’s Garcia and Inge have been two of the surgeons who have brought this specific need to the forefront of the surgical literature.
Dr. Wittgrove presented our results of surgery on adolescents at the American Society for Metabolic and Bariatric Surgery a few of years ago. At that time he presented the second largest series in the United States literature. There was a zero mortality rate, acceptable morbidity rate and the weight loss at two years was even greater than what we had reported for our adult patients. This can be very gratifying for everyone involved and life-changing.