WHEN SHOULD CHILDREN BE CONSIDERED CANDIDATES FOR WEIGHT LOSS SURGERY?

The subject of children and adolescents potentially undergoing weight loss surgery has evolved greatly in a short number of years. When it was initially proposed the only operations were invasive procedures such as the open Roux-en-Y gastric bypass. With the advancements of minimally invasive surgery and laparoscopic instrumentation, there are now several minimally invasive choices, most notably the laparoscopic adjustable gastric band (LAGB, Lap-Band or REALIZE Band). The LAGB procedure does not involve any cutting, rerouting, reconnecting or other irreversible changes to the gastrointestinal system of a young person and so has emerged as a potential procedure, perhaps more worthy of consideration on a wider scale in young people.

The rationale for weight loss surgery being performed among young people is that serious comorbid conditions are developing in young people and extremely important formative events are occurring in social, intellectual, academic and career realms for the young person, all of which are profoundly negatively impacted by obesity. Weight loss surgery performed at a young age offers the potential benefit of impacting not only the young person’s health and quality of life, but also substantially enhancing long term prospects for improved career, earnings, relationship formation and social development. For this reason many advocates of childhood health and adolescent well being have endorsed the concept of offering weight loss surgery to obese adolescents and young people.

When should a young person be considered for weight loss surgery?

  1. When the body mass index is over 35 it is reasonable to begin consideration.

  2. When the body mass index is over 40 weight loss surgery should be included in any discussion with the patient and family of the weight loss options.

  3. Attempts at non-surgical weight loss: young people by virtue of their higher resting metabolic rate than older persons, often have a greater ability to lose weight through non-surgical means. Additionally, young people may have a greater power to make behavior and lifestyle change than older people. So, determined efforts should be made to engage in non-surgical weight loss programs with a structured medically supervised approach involving dietary change, counseling, exercise, psychotherapy, use of protein based meal replacements and support groups. If these efforts fail then weight loss surgery should be considered.

  4. Health status: For adolescents who have already shown health problems stemming from obesity such as type 2 diabetes, high blood pressure and obstructive sleep apnea, weight loss surgery should be a consideration.

  5. Age: At what age should weight loss surgery be considered? This remains a debated topic. Our own center chose a lower range cutoff of age 15 below which we offer non-surgical, medically supervised weight loss. At 15 and above we will offer laparoscopic adjustable gastric banding weight loss surgery. At age 18 and above patients and families generally have the option of LAGB or laparoscopic Roux-en-Y gastric bypass surgery. Other centers around the country have chosen a lower age cutoff of, for example age 12 and above for consideration of weight loss surgery.

Tips for success with adolescents and weight loss surgery:

  1. This must be a whole family effort. Everyone must be educated and motivated to help the young person succeed.

  2. Support groups for the young person and the parents and siblings. This is not a “go-it-alone” journey. Quite the opposite is true. Support, encouragement and coaching from parents, siblings and peers enhances successful weight loss.

  3. 0-calorie beverages. This principle must be enforced within the household to avoid “drinking all your calories” and maintaining resuming obesity.

  4. Protein first. This principle means that everything eaten, drunk, prepared, bought, opened, sniffed or dreamed about must be protein first. This guarantees a greater sense of satiety and an emphasis on lower intake of simple carbohydrates, which are appetite stimulating.

  5. Exercise for life. The habit must be engrained not only for the young person, but for the whole family that daily exercise is part of life even if it is simple walking. Exercise is a powerful predictor of long term weight loss success

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Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

Copyright © 2007-2010 Kent Sasse, M.D. All Rights Reserved.

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