It is no secret that obesity is a major public health concern in this country and throughout the world. Left unchecked, it can lead to medical problems such as high blood pressure, joint pain, high cholesterol, diseased kidneys, liver complications, and a host of others. And sadly, these effects are no longer isolated to adults. In the past twenty years, obesity rates in young people have been on the rise, and weight-related complications are now all too common in children and adolescents.
To combat this disturbing trend, physicians and medical professionals have been supporting initiatives that promote physical education and healthier diets for children. Many schools and after-school programs now promote physical activity and a healthier diet.
However, while these efforts are certainly helping and are vital to the fight against obesity, for some teens they are simply not enough. Many physicians and surgeons across the world now agree that bariatric surgery can be a safe and effective treatment option for severely obese teens — one that can dramatically improve their long-term health and well-being – when all other options have been exhausted.
In order to learn more about this topic, we talked to Dr. Jeffrey Zitsman, the Director of the Center for Adolescent Bariatric Surgery at Morgan Stanley Children’s Hospital at New York-Presbyterian Hospital/Columbia University Medical Center. Part one, below, addresses the current status of obesity in teens. Part two answers questions about the safety and efficacy of weight loss surgery in teens, age requirements, and how the program at New York-Presbyterian/Columbia University Medical Center works.
How common is teenage obesity in the United States?
Dr. Zitsman – Currently, 20% of teens in the United States are classified as obese. There have been strides made by trying to increase exercise programs and pushing to decrease the portion sizes of juices and sodas in school vending machines, but the rate of obesity is still about 1 in 5 for teenagers.
Why is this rate so high?
If you look at studies that have been done over the past 40 or 50 years, there has been a sharp acceleration over the last 20 years in the rates of obesity in children, adolescents, and adults. The rate has leveled during the past few years.
To me, there is no question that this is all about energy imbalance. Perhaps a better way to say that is simply that people are eating more, the concentration of calories is greater so the total caloric intake is higher, and people are less active than they used to be. There are fewer school-funded programs, and I have certain kids who no longer have physical education in their high schools, because the programs have just been cut.
In addition, all this time that kids used to spend outside being active has been replaced by time spent on electronic devices. Probably the greatest exercise that teens get these days is with their thumbs, by texting. When I ask kids in our program how much time they spend watching TV or on a computer each day, the amount is staggering. It can be five or six hours a day on a regular school day. I then ask them how much time they spend exercising, and they say maybe 30 minutes twice a week.
What are some of the health problems that obese teens are most at risk of developing?
Obese teens are much more likely to develop the types of diseases that their grandparents used to get, like diabetes, high cholesterol, and high blood pressure. Twenty-five years ago you wouldn’t think about looking for these diseases in teenagers, but now it is standard practice to screen for them in teens who are severely overweight. Fortunately, with weight loss these health problems can often be reversed.
Additionally, from a chromosomal standpoint, chromosomes in obese teenagers resemble chromosomes of elderly people rather than those of non-obese teens.
Why are diet and exercise ineffective treatments for some obese teens?
Extreme weight gain reflects a problem with eating behavior. I believe people who are obese, by definition, have an eating disorder. Not the same sort of disorder as anorexia nervosa, but there are certain people who develop eating habits that contribute to the consumption of lots and lots of calories.
Psychologically, people eat excessively for many reasons. Some eat because they are hungry, some eat because they are anxious, some eat because the food tastes good and it’s satisfying, and that becomes a way to stimulate pleasure centers in the brain, and the brain likes that so they continue to eat.
As for the food itself, much of it today is very high in calories, and the portion sizes make people eat much more than they need or want. So rather than paying attention to whether or not they feel satisfied, people keep eating until they are stuffed, and there is a lot in society that encourages that.
Is bariatric surgery generally considered safe for teens who qualify?
In our studies, when we looked at both adolescents and adults, we found that obese adults had many more of the health problems associated with excess weight, such as diabetes, sleep apnea, high blood pressure, and others. Weight loss surgery seems to carry the same risk between adults and adolescents, because there are not many anatomical differences between them. The one big difference is that teenagers are generally healthier, so surgery is generally safer in teens than it is in older adults.
How effective is bariatric surgery for teens? Is it more or less effective than it is for adults?
The overall data isn’t in yet, but when we looked at our adolescent patients and we compared them to the patients in the adult program, we found that the results of gastric banding were about the same in both groups. At three years, the average excess weight loss after gastric banding is somewhere in the range of 38-40%.
We have less data available about outcomes after gastric sleeve surgery, but the one-year weight loss is about the same between teens and adults, about 60% of excess weight lost.
At Columbia we don’t perform gastric bypass surgery in teens, although there are programs at other children’s hospitals that do. The adult numbers suggest that excess weight loss after gastric bypass surgery averages about 75-80% in adolescents.