Obesity surgery and teenagers

TThis is becoming an option for overweight or obese teenagers. We are seeing an increase in the number of obese young people and unless action is taken to address this, we could be storing up some serious long term problems.

The teenage years can be difficult in that many young people are struggling to find their identity. They are heavily influenced by their peer group and have a strong desire to fit in with that group. Another aspect is that of body image: most teenagers are very self-conscious about their appearance and go to extraordinary lengths to achieve a certain ‘look’. One aspect of this is the desire to emulate celebrities and models are seen in advertising and the media. The models depicted in various magazines and on the television are young, super skinny and attractive which particularly appeals to young girls.

It is perfectly normal for teenagers, especially girls to put on a bit of weight during adolescence which is mainly due to the physical effects of puberty. However, this can get out of control. Teenagers, particularly young girls are less likely to participate in sports or other physical activities than boys which can cause them to put on weight. Add to this a diet of junk food or too much high fat, sugary food and the problem worsens.

Apart from the physical issues of obesity, there are psychological ones as well. A teenager who is very overweight or obese will experience social isolation, feelings of worthlessness, anxiety and depression. They will find it difficult to form relationships with the opposite sex. Buying clothes can be difficult and embarrassing and in general their confidence and self-esteem. This is a time when they are on a roller coaster with their emotions as well as lacking in confidence. So, to have chronic weight problems as well only makes things worse.

As with children, the answer is to help the teenager to undertake a weight loss programme. This will include advice about healthy eating, exercise and dietary supplements if required. Many teenage girls dislike sports and/or exercise so it is important to encourage them to find an activity they do like. Dance, yoga, Pilates or another type of non-competitive activity are good choices.

If however, diet and exercise has failed to achieve weight loss then surgery is an option. The same criteria apply here as with children and adults: the teenager’s suitability for surgery must be assessed against these criteria.

Should teenagers have obesity surgery?

Providing they are fully aware of the risks as well as the benefits and are able to make an informed, mature decision then there is no reason why they shouldn’t have surgery.

The teenage patient will require the services of specialists in other branches of medicine as well as obesity. This is because the teenager is undergoing puberty and as such there will be other factors to take into account. So, the services of an expert in the field of adolescent medicine will be needed.

Ideally, the teenage patient will have completed their skeletal development (skeleton is fully grown) at around the age of 13 for girls and 15 for boys. Girls tend to mature at a quicker rate than boys (two years ahead) but this is an average figure.

They will have tried a weight management programme for at least six months beforehand. This is exactly the same as it is for adults. Diet and exercise must have been tried first along with weight loss medication if necessary. Only when this has been tried but has failed to work can surgery be then considered.

Research findings do indicate that obesity surgery for teenagers is successful and in many cases has also resolved certain obesity related conditions such as Type 2 diabetes. It also improves their ‘heart health’ as well.

In terms of what type of surgery there are two procedures available for teenagers:

• Gastric bypass
• Gastric band

If a teenager has taken abused drugs/alcohol now or in the past, is
unwilling to make lifestyle changes or commit to an aftercare plan then this is likely to exclude them from surgery. For teenage girls, if they are pregnant or have recently given birth then this too is an exclusion.

NICE guidelines recommend a minimum age of 18 for but, if there are exceptional circumstances then surgery is appropriate. Again, this is something which needs to be discussed very carefully with you and your surgeon (or if you are a parent, between you, your teenage son/daughter and your surgeon).

There is no evidence in place to show the long term effects of obesity surgery on teenagers. But, we do know that if their obesity isn’t treated then an obese teenager becomes an obese adult. This can mean long term health risks and, in the extreme cases, a reduced lifespan.

Arguments for obesity surgery for teenagers

Obesity surgery can be very effective at treating chronic weight gain. As well as weight loss it can lower blood pressure and heart rate and, in many cases has also eased or even cured Type 2 diabetes.

However, it does need to form part of an overall package designed to tackle the problem of obesity. For the teenager this means a sensible eating plan, exercise and advice about good and bad food choices. If the teenager has gastric bypass surgery then he/she will have to take a nutritional supplement – to prevent vitamin deficiencies, on a daily basis for the rest of their life.

It has to form part of a long term plan and means a complete change in behaviour and lifestyle for it to succeed.

Arguments against obesity surgery for teenagers

One of main objections to surgery is that of age: some experts consider teenagers to be too young for surgery and cite the potential risks of doing so. However, evidence shows that the risks are in fact, no greater than for adults. All surgery is risky but complications are rare and many of these risks can be reduced. For example, taking a daily nutritional supplement can prevent any vitamin/mineral deficiencies.

If your teenage son or daughter has a medical condition which is directly linked to their weight problems or are suffering from poor health due to excessive weight then surgery may just be the answer.

It is not however, a ‘lifestyle’ choice: many teenagers are keen to have cosmetic surgery and may view this in the same light. But, they need to be aware of the seriousness of this decision and what it entails, both now and in the long term.

What happens next?

If you are still looking to go ahead with surgery then the first step is to talk to your GP. He/she can advise you about this option as well as being able to refer you to an obesity surgery. We would recommend that you obtain as much information as you can beforehand and talk to other people in a similar situation at a local support group. There will be other young people who are facing the same decision and it can help to discuss this with them.