More teenagers are following Morace’s example. Roughly 140,000 people will undergo gastric-bypass surgery this year, up from 103,000 last year, according to the American Society for Bariatric Surgery. And though no one tracks how many of these patients are under 18, doctors say their numbers are growing. At the Cincinnati Children’s Hospital, a leader in the field, surgeons are performing about 24 such operations per year, up from one just five years ago.
Of course, long before kids become candidates for this type of surgery, parents should try to help them lose weight by replacing fast food with more meals at home and encouraging 30 minutes of exercise per day, says Dr. Thomas Inge, a pediatric surgeon at Cincinnati Children’s.
And even if all else has failed, the decision to allow a child to undergo the procedure is deadly serious. One out of 200 patients dies. Complications can include blood clots and food leaking out of the bowel into the abdominal cavity. After surgery, patients have to take nutritional supplements for life and are limited to eating one cup of food at a time. The surgery and hospital stay cost about $30,000; insurance usually pays for more than 80 percent.
Not surprisingly, many experts feel the operation is simply too drastic. “It is so extreme,” says pediatric nutritionist Robyn Flipse. “We have no evidence of what the long-term effects for a child are going to be.” For that reason, criteria for teenage patients are strict. Inge, who co-authored a paper on surgery guidelines to be published in next month’s issue of Pediatrics, says candidates should have a body- mass index of at least 40, accompanied by a severe condition like sleep apnea or diabetes (box). One less radical option, a removable band that fits around the top of the stomach, is approved for adults, and some doctors use it off-label for teens.
To change a child’s behavior and thinking, it’s critical to find a bariatric program that includes counseling from a nutritionist, an exercise physiologist and a psychologist. (Top centers include Cincinnati Children’s, Children’s Hospital of Pittsburgh, Children’s Hospital of Alabama, Texas Children’s Hospital, Lucile Packard Children’s Hospital at Stanford and Children’s Hospital of Wisconsin). Adolescents who lose massive amounts of weight cope with changes in family dynamics and in how peers treat them. Girls may have trouble handling attention from boys. “When someone is morbidly obese, her social life is often delayed,” says pediatric psychologist Helmut Roehrig.
Yet for some young adults, the surgery feels like a lifesaver. Six weeks ago, 21-year-old Kendra Mollett underwent a gastric bypass. At 330 pounds, she’d hesitated to go out in public. “I was afraid people were staring at me, laughing,” she says. Soon, she hopes, she’ll be turning heads for quite a different reason.
