The first bariatric surgery program for obese adolescents in the St. Louis area has opened in a partnership with Washington University School of Medicine, Barnes-Jewish Hospital, and St. Louis Children's Hospital.
These surgeries promote weight loss by reducing the size of the stomach and limiting food intake.
“We know from the adult experience that surgery is the most effective therapy that provides weight-loss long term,” says Esteban Varela, who performs the surgeries at Barnes-Jewish Hospital. “So we want to provide this same technique and treatments to the adolescent population.”
Childhood obesity has more than tripled in the last 30 years, and there are only a few programs in the country that perform these surgeries.
“The issue is that the obesity problem in the adolescent population keeps growing, and the statistics are really alarming now,” Varela explains. “We have some of the racial and ethnic groups with more than a 40 percent incident of obesity.”
A 2008 report by the National Center for Health Statistics says that 18 percent of adolescents age 12-19, 20 percent aged 6-11 and 10 percent aged 2-5 are obese.
Missouri is among the top five in the country for obesity, especially childhood obesity, Varela says.
A 2001 study shows that 21.5 percent of school-aged children in Missouri are obese.
The problem that these children are facing is that diets don’t work, says Varela.
“The thing is keeping weight down long term,” he explains. “You see people one or two years after a program, like Biggest Loser, and they have gained the weight back.”
Other than the effects that obesity has on a child’s self-esteem, it poses a laundry list of potentially fatal heath risks, including high cholesterol, high blood pressure, abnormal glucose tolerance, heart disease, diabetes, sleep apnea, liver problems, hypertension, endocrine imbalance, gallbladder disease, stress-induced joint disease, and asthma.
Extremely obese adolescents beginning at age 13 for females and 15 for males may be eligible for weight-loss surgery if they have a Body Mass Index above 40. However, they must first attempt the Head to Toe weight management program at St. Louis Children’s Hospital. They must also see a psychologist to determine whether they are mature enough to handle the procedure.
There are three types of minimally invasive weight-loss surgeries available: laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass.
The procedures are meant to be permanent, Varela says, although the laparoscopic adjustable gastric banding or the “lap band” can technically be removed. However, he doesn’t advise people to remove the band at the risk of regaining the weight.
The surgery takes 1-2 hours, and the patient stays 1-2 days afterward. It takes about three weeks for the patient to return to normal activity, though it might take longer for them to return to regular exercise.
“We know from a few adolescents that have been done around the country that the procedure is safe, as safe as adults,” says Varela. “And, the adolescents may present a lower number of complications because, obviously, their problems are not as chronic.”
Varela says that the biggest difference between adults and adolescents is the psychological component.
“The patient goes through a lot of changes after surgery,” he says, “and must be mature enough to handle those changes.”
So far, Varela has performed two surgeries and is preparing to do three more.
“You aren’t going to see hundreds of people getting this surgery,” Varela says. “Selection is important.”
After adopting lifestyle and diet changes by limiting themselves to three small, healthy meals, eliminating junk food and soda, and exercising for at least 30 minutes, patients can expect to lose 50 percent of their excess weight within the first year.
“Surgery should be a tool to help reach weight-loss goals. It’s not a cure, but it’s the best treatment out there.”
