Bariatric surgery can give teens new life

Bariatric-surgery-gives-teen-new-life-HGLN5M4-x Tipping the scales at more than 400 pounds, Keenan Henderson knew he was overweight. But the teen thought bariatric surgery was too drastic a step for someone his age.

"I didn't think it was for me, just because I was 17," he said. "Thinking about doing something that would completely alter my life at 17 was big."

But after he attended a seminar on the procedure with his sister, his interest was piqued.

And in August 2010, he had the surgery. He hasn't regretted it.

"I feel a lot better about myself," he said.

A decade ago, most surgeons shied away from performing bariatric surgery on teenagers. Naysayers feared that the adolescent body would suffer if surgery was performed at such a young age.

Others argued that teens should lose weight through exercise and diet rather than turning to what could be seen as a quick fix.

Over time, that thinking has shifted. Dr. Samer Mattar, a bariatric surgeon with Indiana University Health Pediatrics at IU Health North, has performed the operation sporadically since moving to Indianapolis six years ago.

About 2 and one-half years ago, he and colleagues started the pediatric bariatric surgery program. Mattar estimates he has performed the procedure on 15 to 20 adolescent patients. An additional five to 10 are in the pipeline, he said.

Bariatric surgery is far from a magic bullet. It may jump-start weight loss, but patients have to follow a rigid regimen for the rest of their lives to ensure they remain healthy and do not regain the weight.

"Surgery gives them a head start, a push in the right direction," Mattar said. "They still have to work at changing their lifestyle."

Many of the teens who have surgery already have diabetes, liver disease, high blood pressure and joint problems; their quality of life during high school matches that of many people in early retirement age. They experience social isolation because of their weight. One girl stopped going to the school's library because she was too heavy to climb the stairs to get there; after the surgery, her grades improved markably, Mattar said.

"Yes, there are long-term complications (from the surgery), but there are many more in terms of morbid obesity," said Dr. Theresa Rohr-Kirchgraber, an adolescent medicine specialist at Riley Hospital for Children at Indiana University Health.

Before surgery will be performed, patients must have reached sexual maturity and stopped growing, about age 14 for girls and 15 for boys, Mattar said. But they do not need to have the same health problems associated with their weight, such as diabetes or heart disease, as adults who have the procedure, Rohr-Kirchgraber said; in fact, the idea is to prevent such problems.

They undergo psychological evaluation and spend about six months preparing. Adults typically spend about three months.

"It's not a gall bladder operation where I take the gall bladder out and say, 'You're good, I can discharge you,' " Mattar said. "We follow these patients for life."

In teen patients, Mattar performs the Roux-En-Y surgery rather than installing a band, which requires more maintenance and involves permanently placing a foreign object in the body. The surgery he prefers tends to lead to more dramatic weight loss, which helps encourage teens to stick to a rigorous post-surgical program, he said. People who have had bariatric surgery must avoid foods high in sugar and fat, consume high-protein foods and take vitamins daily.

Cincinnati Children's Hospital Medical Center has had a pediatric bariatric surgery program, the country's first, since 2001. Doctors there have operated on 172 patients.

Patients do lose weight, but analyses suggest that heavier patients do not lose any more weight than those who start with less to lose.

That's good news for those with a BMI in the 40-49 range before surgery. They cease to be obese. But those who have a BMI above 60 continue to be obese and may have health problems associated with the condition, said Dr. Sean Barnett, a bariatric surgeon with Cincinnati Children's Surgical Weight Loss Program for Teens.

"The bottom line of that is send the patients to us earlier," he said. "Don't wait until their BMI is 60 or 65. … Get them to us sooner so we can actually help them."

In fact, studies have shown that 80 percent to 90 percent of obese teens will continue to be dangerously overweight in adulthood.

Henderson, now a Ball State freshman, has undergone a remarkable transformation. Just under 300 pounds at his last weigh-in, he can wear clothes that fit and can go to the gym. He's more outgoing.

"Before, I didn't think I looked like a person, but now I can definitely see that I'm a man," he said.

And last June, he did something his mother never thought he would: He attended his senior prom.

USA Today

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