Adolescents And Weight Loss Surgery

Chapter 4 – Choice Outpatient Weight-Loss Surgery, A Sasse Guide

Adolescents and Outpatient Weight-Loss Surgery Adolescents and children present a particularly challenging subgroup for health care providers, surgeons, parents and families. As surgeons, we want to help, but we are also aware of the complexity of obesity as a disease and its relationship to both the developing psyche and body of a child or adolescent. There has been a good deal of research directed at the topic of weight-loss surgery for adolescents, and the topic remains controversial.78-81 On the one hand, people who emphasize the psychosocial aspects of weight gain and unhealthy habits, decision-making and behavioral aspects of this problem point out that children and adolescents have developing brains and have a greater likelihood of changing their lives and resolving weight problems without resorting to surgical procedures. On the other hand, advocates for overweight adolescents point out that it can be considered cruel to withhold valuable treatment for such a devastating problem. They emphasize that the important years of adolescence – high school and college years – are critical for the formation of healthy relationships, self-esteem and career paths and that these formative years set the compass for the direction of these young people’s lives. Adolescent Success I have performed LAGB surgery on a number of adolescents with strong support of their parents, pediatricians and psychologists. In each case, these adolescents had tried everything to lose weight and understood the seriousness of their decisions. One young man whose parents were both severely overweight felt that he had no chance of attaining a healthy weight in high school without help. Following the LAGB procedure he lost 70 pounds and has moved into his senior year with a much healthier body and much healthier self-image. It is also important to note that the entire recovery process for the out-patient procedure takes about a week. For the young man in question, he was able to have the operation during a break from school and not have to face probing questions about taking a medical leave. The LAGB option allowed him and his family to keep the decision private.

Adolescent weight-loss surgery will probably continue to be a debated topic for years to come, but I think the most important consideration must be the health of the adolescent. In unusual cases where a young person is developing high blood pressure, liver disease and takes insulin for diabetes, we are talking about life-threatening conditions. For other adolescents, the problem of obesity is intertwined with social, behavioral and mood problems and a terrible lack of knowledge about nutrition and health. Physically, adolescents are usually excellent surgical candidates for medical procedures because they tend to be healthier by virtue of being young. They have not had all the extra years to carry around or develop all the extra weight and generally have not developed conditions such as diabetes and heart disease. The decision for a weight-loss procedure extends beyond cosmetic considerations.

With

adolescents,

a weight-loss operation

is

often

proactive – a procedure meant to pre-empt the deleterious physical effects of being overweight that will most likely develop as the child enters adulthood. Our own approach at Western Bariatric Institute has been to perform LAGB surgery for adolescents under the auspices of a research study protocol.82 It requires that adolescents be seen, evaluated and approved by a psychologist and pediatrician, as well as a parent, prior to entering the program. Only the LAGB is offered, because our surgeons feel the fact that the procedure can be reversed is important when the decision for surgery is made for a minor. In the past when the only surgical options available were more invasive and more permanent procedures such as biliopancreatic diversion and

gastric bypass, it made less sense to offer weight-loss surgery to a wide population of overweight adolescents. There would almost definitely be complications to answer for, and the permanence of the surgical intervention could certainly be questioned by those who point out that minors do not have the same level of decision-making capability as adults. Some opponents of adolescent weight-loss surgery would also contend that successful weight-loss surgery requires a high level of commitment on the part of the patient. And since adolescents often lack the experience and maturity to make such a deep commitment to lifestyle changes and healthier habits, they should be made to wait a few years until they reach adulthood. Because the LAGB procedure has a track record of success, a compelling case can be made to make it more available to adolescents. Just as for adults, LAGB surgery is minimally invasive, requiring only a 30-to 40minute procedure, and is reversible with another fairly minimal procedure and few adverse consequences. There are currently no standard criteria for selecting adolescents for weight-loss surgery. Most centers that perform adolescent weight-loss surgery will consider candidates with a BMI of 35 or greater, as long as the parent and the child are committed to long-term success, and the patient passes the psychological screening. Purchase This Book: Outpatient Weight-Loss Surgery: Safe and Successful Weight Loss with Modern Bariatric Surgery.

Copyright 2009 – Dr. Kent C. Sasse www.SasseGuide.com

About the Author

Dr. Kent C. Sasse, M.D., MPH, FACS

K

ent Sasse, MD, MPH, FACS is a nationally renowned authority on surgical weight-loss procedures and a leader in the rapidly evolving field of bariatric surgery.

The distinguished recipient of several awards, including member-

ship in the prestigious Alpha Omega Alpha Society for top medical graduates in the country, Dr. Sasse is founder and medical director of both the iMetabolic International Metabolic Institute and Western Bariatric Institute, a nationally recognized ASmBS Center of Excellence. The recipient of a bachelor’s degree in biochemistry at the University of California San Diego, where he graduated cum laude, and two master’s degrees, including a master’s degree in public health stemming from research related to biostatistics and bioethics, from the University of California Berkeley, Dr. Sasse completed residency training in surgery, focusing on gastrointestinal surgery and physiology, at the University of California San Fran-

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O u t p a t i e n t W e i g h t - L o s s S u r g e r y , A S ass e G u i d e

cisco, as well as fellowship training at the Lahey Clinic in Boston, Massachusetts, before establishing his practice in northern Nevada. Dedicated to the highest levels of scientific research and individualized, state-of-the-art treatment of patients, Dr. Sasse brings a wealth of experience and expertise to the rapidly evolving field of weight-loss surgery. He has written and continues to pursue several IRB-approved research protocols regarding weight loss and weight-loss surgery, and he lectures frequently on topics related to obesity and weight reduction at the University of Nevada School of Medicine. Through his nationally recognized programs, Dr. Sasse and his outstanding faculty provide patients the highest levels of compassionate medicine, scientific evidence, and personalized care in the field of weight reduction. Please visit www.sasseguide.com for more information on Dr. Sasse and his world-renowned programs and facilities.