When to consider weight loss surgery in teens

According to the national survey of children’s health, nearly four in 10 Tennessee children and teens are classified as overweight or obese. Le Bonheur offers a comprehensive menu of options for children and teens struggling with obesity.

One of the options available at Le Bonheur is weight loss surgery. Le Bonheur Bariatric Surgeon Dr. Ying Weatherall discusses this option in the Peds Pod, our hospital podcast.

Six top questions explored in the podcast have been edited for clarity and brevity below.

Host: Can you explain the controversy surrounding this? When is it appropriate for a teen to undergo weight loss surgery and what other options do you try before surgery?

Dr. Weatherall: The controversy with adolescent bariatric surgery is (the question of) are we doing it too early; are we stunting the patient’s growth by having them lose a lot of weight and then are we giving them enough time to try to do the non-operative alternatives, which are diet, exercise and what we call lifestyle modifications.

Host: What are the requirements for a teen to qualify for bariatric surgery?

Dr. Weatherall: So, for a teen to qualify for bariatric surgery; we ask them to be of a certain (body mass index) BMI. So, it’s either a BMI of 35 and over with a major comorbidity, which we classify as type 2 diabetes, obstructive sleep apnea, really severe hypertension or pseudotumor cerebri. These are all diseases that are associated with morbid obesity.

If BMI is over 40, they don’t need to have any comorbidities to qualify for surgery.

In addition to the BMI, we also look at psychological maturity and family support. We want everyone to understand that this is not just a surgery, but it’s a whole lifestyle change and that they have to be very invested in all aspects of the Healthy Lifestyle Clinic.

And then, they also have to be physiologically finished growing because we don’t want to blunt their height growth as part of the surgery. 

Host: So, Dr. Weatherall, this sounds like it’s mainly for kids in their upper teens, is that right?

Dr. Weatherall: Right, so technically girls are usually finished growing around 14 and for boys around 15. So, we start talking to them around that age, knowing that this process takes about six months to a year. Before we actually do surgery, they all get a bone age (test) to make sure that their bones are fused and that they are done growing. 

Host: What types of bariatric surgery do you perform and how does it work to promote weight loss?

Dr. Weatherall: So, at Le Bonheur we do laparoscopic sleeve gastrectomy, which is the most common type of bariatric surgery performed in the United States.

Essentially, we make the stomach about a tenth of its size by removing the majority of the stomach with a stapling device. So, the stomach basically looks like a sleeve, and that’s why it’s called a sleeve gastrectomy. 

Host: Right and what are the outcomes then and what have you seen from bariatric surgery in teens?

Dr. Weatherall: So, the outcomes – the adult population has a lot of long-term studies and then in the teen population there is a three year outcome study from the Teen-LABS Group – really the long-term follow-up and outcome is that they will lose about 30% of their starting body weight. So, for our patients who started at 300 pounds, they’ll lose 100 pounds. Some patients will lose more. Some patients lose less. But as an average, they should lose a third of their starting body weight for the bariatric surgery to be considered a success. 

Host: So, do we have any results yet of the consequences of teen bariatric surgery?

Dr. Weatherall: So… one bad thing about teen bariatric surgery that we have to be aware of and we have to try to avoid is nutritional deficiency. So, after bariatric surgery the amount of food allowed is very small because of weight loss and lack of appetite, which happens after a sleeve gastrectomy. So, patients don’t like to eat but you have to remind them to take vitamins. And this is the same for adults. Everybody has to take vitamins. 

But for the kids, we found that there is a significant increase in iron deficiency. For this reason, we make that part of the preoperative education for all of our patients.

But otherwise, there have not really been any bad or adverse outcomes associated with bariatric surgery in adolescents that we’ve found. 

Host:  What is the follow-up process post-bariatric surgery?

Dr. Weatherall: After bariatric surgery, we see patients regularly (one week, three weeks, then seven weeks) to advance their diet stages and then we see them every three months for the first two years to check vitamin levels and to monitor their exercise and weight loss. After that, we see them annually. 

To view our full podcast library, please visit www.lebonheur.org/podcast.