April 28, 2011
Gastric Surgery for Teens: When All Else Fails
Four years ago, when she was fifteen years old, Michelle Montanti lost over 100 pounds. But she didn’t do it through dieting or exercise–instead, she went under the knife.
It was the best thing she has ever done.
“I’m so happy I did it,” says Michelle, now 19 and a student at Le Cordon Bleu Cooking School, in Los Angeles, where she plans to use her culinary skills to help other teens learn that eating healthy can be delicious and easy.
Michelle wrestled with the scales her whole life, weighing 246 at her heaviest (she’s 5’2″). Like most overweight kids, she was relentlessly teased, and it only got worse when she entered high school. She tried every conceivable diet from vegan to liquid protein, but none worked. As for exercise, she was too heavy to even to do a simple sit-up.
Six years ago, her mother, Mary Lou Mangola, got gastric bypass surgery and thought it was something her daughter should consider too. Never mind that she was only fifteen.
“I was the one that advocated the whole thing,” says Mary Lou, now 50, who has also lost 100 pounds. “It took me six months and many ‘no, no, no’s’ but I did it. I convinced the doctors that Michelle was mature enough, and that there was no other way to do it. I knew what it was like to be a heavy adolescent.”
It was also necessary, she says: Michelle was borderline diabetic, “borderline everything,” says Mary Lou. “If she had kept going she would have had more and more problems.”
After six months of back and forth, Mary Lou finally convinced the doctors to do the surgery on her daughter. She also convinced Blue Cross Blue Shield to cover the expenses, which hovered around $20,000. Michelle got a Roux-en-Y procedure with Dr. Theodore Khalili at the Khalili Center for Bariatric Surgery in Beverly Hills, CA. (The procedure involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.) Since then, Michelle has lost over 100 pounds, and she often shares her story with other kids struggling with weight.
“If I can just help one of them, then I’m happy,” she says.
Michelle is one of a growing number of teens who are getting gastric bypass surgery to help them shed poundage. And rates of gastric or Lap-Band (a reversible procedure in which an inflatable band is placed around the upper part of the stomach, thus limiting the amount of food that can enter) are increasingly popular amongst teens as well, even though the FDA has not approved this procedure yet for teens and so insurance won’t cover it.
And though there have not been any long term outcome studies on teens, a February, 2010 report in the Journal of the American Medical Association (JAMA) followed 50 Australians between 14 and 18 with body mass indexes of more than 35. Half received gastric bypass surgery; the other half took part in a lifestyle intervention that included individualized diet plans, exercise, sessions with a personal trainer, and follow-ups with healthcare providers. Both groups were tracked for two years. The twenty-four surgery patients who finished the study lost an average 76.3 pounds, about 28 percent of their total body weight. The equivalent for the diet-and-exercise group of 18 who completed the study was 6.6 pounds, or 3 percent of body weight.
On the other hand, a recent study in Pediatrics found that two years after sixty-one 17-year-olds had gotten gastric bypass (a procedure in which the stomach is reduced from the size of a football to that of a golf ball), their bone mineral content had declined, on average, by 7.4 percent. And long-term adult studies have found that a certain amount of adults who undergo surgery gain their weight back.
So with all these different takes, it’s hard to know what to do. But there are some very good reasons why an adolescent might get surgery. For starters, “The emotional toll from being an obese teenager is huge,” says Joseph A. Skelton, MD, a pediatric gastroenterologist and director of the Brenner FIT (Families In Training) Program at Brenner Children’s Hospital, at Wake Forest University Baptist Medical Center in Winston-Salem NC. He cites a 2003 JAMA study that found that obese children rate their quality of life on a par with kids with cancer.
What’s more, doing something earlier rather than later may have long- lasting health implications. “If you’re pre-diabetic or diabetic, have sleep apnea or bone problems — if you don’t do something now you could have permanent disability,” he says.
That said, he stresses that surgery should only be a last resort for kids, who must demonstrate, as Michelle Montanti did, that they’re committed to lifestyle and behavioral changes.
Dr. Michael A. Snyder, a bariatric surgeon in Denver, Colorado, believes the onus has to be on the patient–and not his or her parents. “I make kids go through a lot of medical screening, attend a multi-part clearance along with their family, and lose some weight on their own,” he says. “If a kid wants to lose weight, they have got to start monitoring themselves. They have to show that they’re committed to the process.” They also have to show that they’re committed to the post-surgery process, which includes eating smaller meals, not drinking during a meal, cutting out sugary foods and carbonated beverages, and also taking vitamins and supplements.
Indeed, if you don’t change your habits, you can come down with a very unpleasant situation called “Dumping syndrome,” which involves copious amounts of diarrhea and vomiting. That’s what happened to Ryan Loney, 17, who got a non-surgical gastric balloon in June 2010. The procedure, which is available in Europe, Australia and Latin America but is not yet approved in the US, takes about 5 minutes and involves putting a deflated balloon in your stomach through your mouth. Once positioned in your stomach, the balloon is filled with water, also through your mouth. It has a self-sealing valve. It stays in your system for six months making you feel full and eat less, all the while you are getting diet/nutrition/exercise/lifestyle counseling. After six months, the balloon is removed, and, theoretically, anyway, patients have the tools to continue their weight loss (they’re also given counseling support for half a year).
“In the first few weeks I was getting sick when I tried to eat the way I did before, but after that I felt fine as long as I ate the right things and didn’t overeat,” he says. Six months later he had lost 72 pounds. “Now I am eating smaller portions and feeling more satisfied from less, and best of all, I am able to do the things I love to without getting hurt.”
