Weight Loss Surgery for Teens: Part Two
In part two of our article on bariatric surgery in teens, Dr. Jeffrey Zitsman answers questions about the safety and efficacy of bariatric surgery, age requirements for surgery, and how the program at New York-Presbyterian/Columbia University Medical Center works.
To read part one of the interview with Dr. Zitsman follow this link: Weight Loss Surgery for Teens: Part One.
What is the minimum age requirement for bariatric surgery? Do you think this is going to change in the near future?
Dr. Zitsman – A number of factors affect the minimum age requirement for bariatric surgery. Because this is in large part a behavioral problem, one has to take into account the willingness of a young person to change his or her behavior.
In other parts of the world, particularly in Saudi Arabia, there have been children under the age of ten who were severely obese and successfully underwent weight loss surgery. In the United States, the Pediatric Committee for the American Society of Metabolic and Bariatric Surgery has discussed this matter. Our consensus is that adolescence is really the boundary for performing weight loss surgery, and the World Health Organization defines adolescence as starting at age ten. However, aside from age, we look at other physiological factors such as sexual maturity and bone age growth when deciding whether or not bariatric surgery is appropriate in adolescents. With all these factors taken into consideration, the average age of adolescents undergoing surgery in our program is 16 years old.
We are cautious about offering surgery to anybody at the younger end of the age spectrum, due to the concern that interfering with somebody’s adequate nutrition at a young age may result in incomplete growth, short stature, and possible incomplete development of other body structures.
We also wanted to steer clear of putting an exact age on this recommendation, because if somebody comes in and they are eleven years and eleven months old, is there some magic reason to wait a month until they are twelve? That would seem sort of arbitrary, so it is more of a general concept. Now, there may be an occasional argument for compassionate use of surgery for somebody younger than the standard age, but that has to be a particularly severe case that stands out in our program, which already employs a very rigorous screening process.
Although not generally used in teenage operations, it seems that gastric banding would be a safer procedure to offer, since it is not as invasive. So why is this procedure not performed more often in teens?
Laparoscopic adjustable gastric banding is a safer procedure, but the FDA has not approved bands for use in patients younger than 18 years. I don’t think there is any question that it is the safest of the commonly available operations. However, it is probably the one that most depends on the individual changing his or her eating behavior. Given that variable, the results are generally not as good as an operation that has a physiological element of removing a portion of the stomach. For that reason, for anybody under the age of 18, sleeve gastrectomy is the operation that we offer here at New York-Presbyterian/Columbia University Medical Center.
Do you think that bariatric surgery for teens is going to become more common in coming years?
I don’t think that the rates are going to go down particularly, but I am not sure they are going to go up either. If 20% of the population remains obese, and severe obesity represents 4-5% of the obese population, that still puts about a million people in the adolescent age group who could potentially be candidates for surgery.
How does the weight loss surgery procedure for teens work at New York-Presbyterian/Columbia University Medical Center?
The process itself begins with a small group of patients and their parents meeting with me to talk about obesity and weight loss surgery. For patients who are interested in learning more, I meet with them individually afterwards. If they and their parents then decide to go through our program, there is a six-month process of evaluating eating and exercise behaviors. Additionally, during this time, patients undergo a thorough medical evaluation and a thorough psychiatric evaluation to make sure they are physically and emotionally mature enough to make the necessary lifestyle changes associated with weight loss surgery. This screening process is very rigorous and selective. Our program is one of the busiest in the country and in eight years we have screened about 500 patients.
There are not many programs like ours. Surgery is only one component of any successful weight loss program. Dietary counseling, exercise counseling, and management of multiple medical problems associated with obesity all take a lot of manpower. They take a lot of effort, and multidisciplinary collaboration is really essential to any program being successful. We are fortunate to have a dedicated team of specialists who commit their time and energy to helping obese adolescents achieve success after their operations.