Weight Loss Surgery in Adolescents

Weight loss surgery is now accepted as the most effective treatment for morbid obesity.  Successful weight loss often results in improvement or resolution of obesity-related health problems such as pre-diabetes, sleep apnea, high blood pressure, and cholesterol abnormalities. The Center for Adolescent Bariatric Surgery (CABS), which opened at NewYork-Presbyterian Morgan Stanley Children's Hospital in 2006, has evaluated over 500 adolescents for weight loss surgery.

This multidisciplinary program for weight management includes experts in pediatric gastroenterology, endocrinology, nutrition, mental health, surgery, and other specialties.  Because the program integrates physicians with long expertise and specialty care, patients can be assured that they are receiving the highest level of care available.

Who is a Candidate for Surgery?

Most young patients initially come to our center already diagnosed with insulin resistance, hypertension, irregular periods, joint pain, or other conditions associated with their obesity. Like the adults who receive treatment in the Center for Metabolic and Weight Loss Surgery at Columbia University Medical Center, adolescent patients undergo rigorous education and a lengthy program of multidisciplinary evaluation to determine whether weight-loss surgery is appropriate for them. For adolescents with a body mass index (BMI) over 40 who are unable to achieve or maintain adequate weight loss despite intensive medical regimens, weight loss surgery may offer the best opportunity for successful weight reduction.

To qualify for weight loss surgery adolescents must have a body mass index of >40 kg/m2, or >35 kg/m2 with significant associated illnesses. Not every adolescent is considered a good candidate for weight loss surgery, however. Since successful weight loss mainly depends on changing eating behavior, our multidisciplinary team evaluates patients on a monthly basis before scheduling a weight loss operation. The team looks for patients to make healthy changes in their eating habits, omitting caloric drinks and minimizing high calorie snacks. Exercise is also proscribed and evaluated. Candidates who meet standard National Institutes of Health weight loss criteria and show positive changes in eating and exercise habits may then be offered weight loss surgery.

Weight Loss Procedures in Adolescents

Between 2006 and 2011 laparoscopic adjustable gastric banding was offered to patients at MSCHONY who participated in an FDA-approved clinical trial for adolescents. Gastric banding is still available to morbidly obese adolescents after their 18th birthday (bands have not been approved by the FDA for use in teenagers outside of clinical trials).

Since 2010 our program has been offering laparoscopic sleeve gastrectomy for morbidly obese adolescents. The sleeve gastrectomy is a procedure for surgical weight loss whereby approximately 85% of the stomach is removed, dramatically reducing the patient's capacity for food intake. This procedure is performed laparoscopically through five small incisions. Patients are routinely observed in the hospital for 2 days: on the first day a contrast study is obtained to assess the anatomy of the stomach and to check for any narrowing or leaks. Patients are then discharged on a liquid diet the following day. They advance to a puree diet for several weeks after which solids are introduced.

Outcomes

Obesity is a chronic disease, so successful treatment requires long-term follow-up. Patients who have undergone sleeve gastrectomy in our program have been followed up to five years to date. At 12 months after surgery, patients undergoing this procedure lose 60% of their excess weight, or 80 pounds, on average. Patients also show significant improvement of co-morbid conditions. We continue to follow all patients post-operatively to provide care and to collect results so that others contemplating weight loss surgery are able to make informed decisions.

Steven Stylianos, MD Chief, Division of Pediatric SurgeryJeffrey L. Zitsman, MD, Director, Center for Adolescent Bariatric Surgery