Twenty years ago, weight loss surgery for teenagers was considered a rare and risky last resort, with little data on what happened to patients long-term. Even a decade ago, half of family doctors said they'd never recommend it.
Today, with one in 11 teenagers severely obese and research showing surgery can improve lifelong health, many doctors say that for some youths, the benefits outweigh the risks.
"We have found that the weight loss is durable over the long haul for the majority of teenagers and the high blood pressure, diabetes, and high cholesterol go away and stay away," says Thomas Inge, MD, director of adolescent bariatric surgery at Children's Hospital Colorado in Aurora.
In one of the first long-term studies of teen patients, Inge followed 58 who’d had gastric bypass surgery, which makes the stomach smaller. Patients' average body mass index (BMI) fell from 59 before surgery to 36 a year later and 42 eight years after surgery, a loss of about 110 pounds, or 30% of body weight. The number with diabetes plummeted from 16% to 2%, high cholesterol rates fell from 86% to 38%, and high blood pressure dropped from 47% to 16%.
Notably, two-thirds remained obese (a BMI of 30 or greater). The less they weighed at the time of surgery, the better they fared.
"We found that the window to get back to a normal weight, or even to obese, closes quickly after you become severely obese," says Inge. "If you make the mistake of ignoring the problem too long, the opportunity may be sadly missed."
Another study compared 81 obese teenagers who had surgery with 80 who did not. Five years later, those who had surgery had kept one-third of their original weight off, while those who didn't gained weight.
The American Society for Metabolic and Bariatric Surgery recently updated its guidelines for youths, stating that "it has become clear that surgery is a safe and effective treatment" and urging doctors to get over the "stigma."
Inge says surgery is only for severe cases. Common risks include hernias, bowel obstruction, gallbladder stones, and a lack of nutrients.
He recommends it only for teens with a BMI of 40 or more (235 pounds for a person who is 5 foot 4) or those with a BMI of 35 or more who have diabetes, non-alcoholic fatty liver disease, or sleep apnea. He advises new patients to try lifestyle changes and medications for 6 months before committing to surgery.
For those who opt for it, the results are often life-changing.
"They report less pain in their joints, they feel more vital, their relationships are improved, and they gain the ability to achieve simple life goals that the rest of us take for granted," says Inge. "It's truly a metamorphosis."
By the Numbers
- 8.5%: Percentage of youths ages 12 to 19 who are severely obese, while 18.5% are obese
- 1,500: Number of adolescents who have weight loss surgery annually. In 2000, only 200 did.
- 3-5: Number of times youths who are severely obese in childhood are more likely to die of a heart attack in adulthood
- 70%: Percentage of teens seeking weight loss surgery who have sleep apnea
- 59%: Percentage of teens seeking weight loss surgery who have non-alcoholic fatty liver disease
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