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Weight-loss surgery for teens is lauded, debated

This article first appeared in the St. Louis Beacon, Dec. 13, 2010 - For most of her life, Brittany Lewis, 18, has ridden a dieting rollercoaster.

Before hitting a high of 289 pounds on her 5-foot-3-inch frame, the Wood River, Ill., resident tried every imaginable weight-loss program.

"Weight Watchers, Atkins, diet pills, counting my calories and just cutting back," Lewis said. "They all worked a little bit, but I've always gained the weight back -- and then some."

Last June, Lewis took a controversial step for a teenager: bariatric weight-loss surgery. Since then, she's lost 72 pounds, with 70 more to go.

Lewis is now a self-assured, on-the-go community college student who works out three times a week.

"I used to be scared to go anywhere," Lewis said, remembering how peers stared at her or made hurtful remarks that she overheard. "Now I have a lot of self-confidence, and I'm just constantly running around."

Candidates Thoroughly Tested

During the past three decades, the obesity rate among U.S. teens has more than tripled. Today, 18 percent of all teenagers, numbering about 5 million, are considered obese with a body mass index (BMI) of 30 or more. Certain minorities are hit hardest: As many as 40 percent of African-American girls and Mexican-American boys struggle with obesity.

Studies show obese adolescents are more likely to become obese adults, increasing their risk of heart disease, diabetes, stroke and premature death. Many develop life-threatening conditions while still in their teens.

To address the dangers of teen obesity, Washington University School of Medicine, St. Louis Children's Hospital and Barnes-Jewish Hospital have opened the first area program for adolescent bariatric surgery. Lewis is the first -- and so far the only -- surgical patient. A few others are in the queue.

Approval for the surgery -- sanctioned by the National Institutes of Health for girls as young as 13 and boys of at least 15 -- is contingent upon passing several rigorous tests. To begin with, they must have a BMI of at least 40. For someone 5 feet 10 inches tall, that translates into more than 280 pounds.

"They are also evaluated by a psychologist, a nutritionist and a social worker," said Washington University surgeon Esteban Varela. "We validate family support, and candidates undergo a minimum of six months of supervised medical weight loss and an assessment by the surgeon."

Is Surgery Too Drastic For Teens?

While weight-loss surgery for adolescents is hotly debated, almost everyone agrees on one thing: It works for many patients. An Australian study of 50 teenagers published earlier this year showed that 84 percent of those who underwent gastric lap band surgery -- the same reversible operation that Lewis had -- lost more than half of their excess weight, compared to only 3 percent of the teens who just made lifestyle changes.

Complications, such as infection, after weight-loss surgery are rare, according to Varela.

"We know that surgery is not only safe; it's the only method that provides sustained weight loss over time and solves most of the major conditions related to obesity," Varela said. "Surgery is seen by many as a drastic approach, but we are facing a very drastic problem. How many kids are going to die in their 30s who don't have the operation?"

But not everyone is on board. A 2007 survey of 750 physicians and pediatricians found that half would not recommend the surgery to teens younger than 18.

SSM Healthcare pediatrician Heidi Sallee opposes surgery for obese teens who are still free of associated health problems. One of her reservations concerns the stringent post-surgical diet and exercise requirements. Modifications include eating three small, healthy meals daily; abstaining from soda and junk foods; and exercising at least 30 minutes a day. Those are changes some adolescents may find difficult to make while living with their parents.

"So many times you see families with overweight children and the whole family is overweight, which makes it harder," Sallee said. "It would be really nice to have a magic pill or magic surgery and then you never have to worry about it, but that's not reality. Patients still have to make significant changes to their lifestyle."

Nadim Kanafani, assistant professor of pediatrics at Saint Louis University School of Medicine, is concerned about the absence of information about how the surgery affects the patients' vitamin absorption and other nutritional issues.

"The big unanswered question is: What is the overall impact on these people's health, long term?" Kanafani said.

Still, Kanafani believes weight-loss surgery is a necessary option for teens who meet the criteria.

"It is hands down the most effective current management tool in our arsenal for durable and significant weight loss in severe obesity," Kanafani said.

Most bariatric weight-loss surgeries last one to two hours, and patients remain in the hospital for up to two days. After two weeks, most resume normal activities. Insurance typically does not cover the average $23,000 price but sometimes weight-related health problems can justify a policy challenge.

"We can make a case for medical necessity in a severe case of obesity for an adolescent who has high blood pressure or diabetes," Varela said.

Lewis' United Health Care insurance did pay for her surgery. Six months later, she envisions a bright future that once seemed out of reach.

"Before the surgery I felt like if I went to college that I would drop out because people would tease me or I would think they were," Lewis said. "Now I see myself continuing college and graduating and having a very successful life."

Nancy Fowler Larson is a freelance writer in St. Louis.

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