Stomach Surgery for the High School Set

Advocates call it life-changing for obese teens; critics say it should be a last resort

(HealthDay is the new name for HealthScoutNews.)

SATURDAY, July 5 HealthDayNews) -- Three years ago, Zac Reynolds was an unhappy 15-year-old who'd often stay home on Saturday nights, choosing solitude over invitations to go out with friends.

No more.

Today, the Hampton, Va., teen has a zest for life and he's much more outgoing. Besides enjoying time with friends on a Saturday night, he's finishing his senior year of high school, works as a part-time landscaper and spends his spare time tinkering with his car.

His life, he says, has taken "a 180-degree turnaround. Everything seemed to get more positive."

What made the dramatic difference? A 143-pound weight loss, thanks to a type of obesity, or bariatric, surgery that drastically reduces the size of the stomach.

Reynolds, who is 5-foot-7, weighed 318 pounds before his gastric bypass surgery. Now, he weighs 175.

While health experts are divided over the wisdom of performing such surgery on teens, Reynolds is sure it was the right decision for him.

"I had tried a lot of the diets that are out there. None of them worked very well," he says.

Proponents of such surgery for teens -- including Reynolds' surgeon, Dr. Harvey Sugerman -- say it can be life-changing for the right candidates.

Critics caution that bariatric surgery, especially for teens, must be a last resort, and they worry about the procedure's effect on normal growth patterns.

The debate won't die down soon, statistics suggest. Roughly 15 percent, or 9 million American children and teens aged 6 to 19, are overweight, according to the National Center for Health Statistics, citing data from 1999 and 2000. That's triple the number who were overweight in 1980.

Gastric bypass surgery is the best solution for certain obese teens, says Sugerman, the David M. Hume Professor of Surgery at Virginia Commonwealth University.

"We don't think this should be done unless the adolescent has significant medical problems related to their obesity," he says.

Often, they do have such problems.

Reynolds, for instance, was struggling with knee trouble caused by his weight. "And there is a history of diabetes in my family," he says; the doctors were worried he might be prone, too.

Some obese teens have sleep apnea, a condition in which breathing stops temporarily during sleep. And young women can suffer from polycystic ovary syndrome -- when ovulation stops.

To critics who say bariatric surgery shouldn't be done on teens who are still growing, Sugerman says, "We don't feel that's a good argument."

In a 20-year review of 33 teen bariatric surgery patients published earlier this year in the Journal of Gastrointestinal Surgery, Sugerman and his team found that none had delayed or impaired physical or sexual maturation.

Their average body mass index (BMI) was 52 before the surgery. After the surgery, the teens' average BMI was 38. (BMIs of 25 and higher are termed overweight; those 30 and above are considered obese. For instance, a person who is 5-foot-8 and weighs 342 pounds has a BMI of 52.)

The teens who had the surgery also reported enhanced self-image, Sugerman says.

But the operation isn't a magic bullet, as Sugerman cautions: "It is a tool to help them help themselves. It is not a free ride, not a be-all-and-end-all."

While the surgery is designed to provide built-in calorie restriction due to the smaller stomach size, "it can be beaten with the ingestion of high-fat junk food," Sugerman says.

Procedures vary, but the one done on Reynolds "involves making a very small stomach pouch and then you disconnect the upper part of the stomach from the lower and make it a tablespoon-size stomach," Sugerman says.

After the operation, teens are counseled about diet. "We try to get them to eat a balanced, regular diet without potato chips," Sugerman says. Exercise is recommended, too.

Reynolds, who walks for exercise and gets plenty of physical activity during his landscaping job, says he also watches what he eats. If he slips up and consumes high-fat fast food, he says, "it gives me a stomachache."

Despite the success stories, not all doctors are convinced such drastic surgery is right for young patients.

Dr. Timothy Sentongo is a gastroenterologist at Children's Memorial Hospital in Chicago who does not perform bariatric surgery. He says, "We need more studies to find out how safe the surgery is."

Even after those studies are in, such surgery should not be "the first approach," Sentongo adds. He does see a limited role for it if diet and exercise fail and the teen's health is compromised by the obesity.

Parents and teens who think bariatric surgery might be an option should choose their surgeon carefully, says Sugerman. He recommends a surgeon with lots of experience.

"See if the doctor is board certified as a surgeon. Find out if he or she is a member of the American Society for Bariatric Surgery," he advises.

More information

For more information on obesity among teens, see the National Center for Health Statistics. For details on obesity surgery, visit the American Society for Bariatric Surgery.

SOURCES: Harvey Sugerman, M.D., David M. Hume Professor of Surgery, Virginia Commonwealth University, Richmond; Timothy Sentongo, M.B.B.C.h., gastroenterologist, attending physician and assistant professor, pediatrics, Feinberg School of Medicine, Northwestern University, and Children's Memorial Hospital, Chicago; Zac Reynolds, gastric surgery patient, Hampton, Va.
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