Teen weight-loss surgery: Is benefit worth the risk?
Flipping through her yearbook, Kendall Brasch points to a double-chinned girl hiding behind a curtain of brown hair. "This is the 'before,' " says the beaming Sammamish 16-year-old...
Seattle Times staff reporter
"This is the 'before,' " says the beaming Sammamish 16-year-old wearing fitted jeans and a glossy ponytail pulled high on her head. "I can't wait for senior pictures for the 'after.' "
When her junior picture was taken in September, Kendall was "morbidly obese" more than 100 pounds overweight and morbidly unhappy.
After years of failed dieting she had completely given up. She stood a little over 5 feet, 3 inches tall and weighed 265 pounds.
"I was so depressed I didn't care about anything," she recalls. "I would go to school wearing pajamas, wouldn't talk to anyone and come home and sit in front of the TV."
Her breaking point came when she sneaked into her older sister's diary and read descriptions of herself languishing on the couch. "She was comparing me to a beached whale and I realized it was true," Kendall says.
In January, Kendall joined an increasing number of obese teens who undergo stomach-reduction surgery. Doctors used staples to reduce her stomach to a pouch the size of a golf ball, then cut her small intestine and reattached it to the pouch. Now when she eats, her tiny stomach grows full quickly and her shortened digestive tract absorbs fewer calories.
She's lost 105 pounds and counting and says, "I'm ready to really start living."
Some experts worry about what that new life has in store for her.
An estimated 95,000 people this year will undergo weight-loss surgery, with each operation costing $15,000 to $50,000. There are no statistics on how many are minors, but doctors across the nation say the number is increasing.
A decade ago, the National Institutes of Health recommended against the procedure in adolescents. But with 15 percent of 6- to 19-year-olds considered overweight or obese, demand has doctors rethinking the issue.
"With teens there are two ways to look at it," says Dr. E. Patchen Dellinger, chief of general surgery at the University of Washington Medical Center, who has done the surgery on a handful of minors. "They have a longer time to benefit from the weight loss but also a longer time to discover and be affected by the side effects."
Like Dellinger, many other local bariatric surgeons the type of doctors who perform weight-loss operations are on the fence about the surgery for minors. Most have operated on some youngsters and even seen impressive results, but none is completely comfortable with the trend because there are too many unknowns.
How young is too young? How fat is fat enough? What type of weight-loss surgery is best for kids: gastric-bypass surgery, the gold standard in adults, or an alternative that involves implanting a silicone ring around the stomach?
A group of pediatric-obesity experts has developed guidelines that call on surgeons to raise the bar for operating on minors. An otherwise healthy adult who is 5 feet, 5 inches tall and weighs 245 would fit the current criteria for surgery; under the guidelines pending publication, a teenager that height would have to weigh 300 pounds to be considered.
The proposed recommendations say the minimum age should be 15 for boys and 13 for girls, who develop faster. The teens also should have nearly reached sexual maturity and their adult height.
Dr. Richard Thirlby, a bariatric surgeon at Virginia Mason Medical Center who has operated on a handful of older teens, considers emotional maturity, not just physical. He doubts patients under 16 can comprehend they are committing to "never eating like a normal person for the rest of their lives."
Adolescents are notorious for ignoring doctor's instructions, a dangerous prospect when lifelong vitamins and possibly shots may be needed to prevent serious complications.
But some surgeons, faced with desperate kids, say the greatest risk could be doing nothing.
Obese teens usually grow into even more obese adults and, Tacoma surgeon Myur Srikanth says, suffer years of emotional trauma and possibly permanent damage to their health.
A recent survey in the Journal of the American Medical Association showed obese children rate their quality of life as low as do young cancer patients undergoing chemotherapy. Some even develop serious adult diseases such as type-2 diabetes, high blood pressure and aching joints by adolescence.
"Why not intervene before their obesity causes lifelong physical and psychological scars?" Srikanth asks.
Dr. Alan Wittgrove, the San Diego surgeon famous for operating on pop singer-turned-Playboy-centerfold Carnie Wilson in a live Webcast, says his experience operating on 37 youngsters has convinced him the procedure he performs a gastric bypass done through small punctures with a laparoscope is safe and effective for teens.
A year after surgery, his young patients had lost an average of 82 percent of their excess body weight, even more than the 70 percent loss typical in adults. None of the patients died. There were several complications, including infections and an obstructed intestine, but there were too few cases to compare the complication rate to that of adults.
About 7 percent of adult gastric-bypass patients suffer from complications ranging from hernias to blood clots that travel to the lungs. An average of one or two in every 200 dies.
Surgeons agree the procedure, in the short term at least, is safer in young people than adults because they usually don't have obesity-related ills such as high blood pressure and heart disease problems that make operating risky.
The question remains how it will affect them many years out.
"We don't have any follow-up on gastric-bypass surgery going past 15-20 years," Dellinger says. "When you operate on a teenager, you hope they have 50, 60, 70 years ahead of them, but after gastric bypass we don't know what that looks like."
Dellinger usually screens out youngsters, but he has operated on a few severely obese older teens who were developing health problems and whom he deemed mature enough to understand the risks.
Among adult patients, 30 percent suffer from nutritional deficiencies such as anemia or osteoporosis because their bodies aren't absorbing enough vitamins and minerals. Many must take supplements or receive shots for the rest of their lives.
Dr. Sue Kimm, an expert in childhood obesity at the University of Pittsburgh, worries these side effects may be amplified in youngsters. She asks: Will chronic nutritional deficiencies starting in childhood affect learning? Sexual development? Intestinal diseases? No one knows for sure. But most doctors agree surgery on a growing child would likely stunt height.
Osteoporosis at 26
Despite taking eight daily vitamin pills, including calcium, the 6-foot-2-inch man from Belfair, Mason County, developed the brittle-bone disease after dropping from nearly 400 pounds to his current weight of 215.
All that remains of his fat is a flap of empty skin where his belly used to hang over his belt. He says the skin will be removed this winter when he undergoes a tummy tuck.
He received a more drastic form of gastric bypass than Kendall Brasch. Tacoma surgeon Ross Fox rerouted a longer length of Matthews' intestine so he would lose more weight. As a result, he absorbs fewer nutrients and was left particularly vulnerable to calcium deficiency.
Teen years are prime time for developing bone mass, so Kimm says it's no surprise someone who underwent this surgery in adolescence would develop the fragile bones associated with frail, older women.
The now almost-lanky Matthews, who works as a construction worker, takes the bone-building drug Fosamax to help prevent fractures in the future. He also suffers from severe anemia and must receive monthly shots of iron and vitamin B-12.
"I thought it would be a magic bullet and I would just be thin," he says. "I didn't really realize I'd be dealing with this stuff the rest of my life."
Despite his difficulties, he says he'd have the surgery again "without a doubt." To understand why it's all worth it, he says, you'd have to have lived the first 17 years of his life.
At his parents' urging, he began dieting with the Richard Simmons plan at 5. By junior high he would hide in the library at lunchtime to avoid the piggy noises kids made at him in the lunchroom. By high school, he was on Paxil for depression and anxiety.
Without surgery, he says: "I'd probably still be lying on my parents' couch. I don't think I ever would have done anything ... gotten a profession, bought a house, been with a woman."
At first her father, Craig Brasch (who works at The Seattle Times) thought the surgery was too risky. But Kendall's descent into depression convinced him this was an emergency. "We took her to the family doctor, psychologists, tried antidepressants. Nothing worked."
Dr. David Simonowitz, a bariatric surgeon at Overlake Hospital Medical Center, was leery until he saw her parents' desperation and determined she understood the ramifications of surgery.
Insurance covered 80 percent of the $50,000 surgery.
Six months later, Kendall is so thrilled by the results that she glosses over the unpleasant parts stomach pain that kept her in a recliner for weeks, a month of near-constant vomiting, and the discovery that a nibble of chocolate could turn her stomach upside-down and send her into cold sweats.
Pointing out yearbook pictures of classmates draping arms around each other at football games and dances, she says: "I have another year, another chance to do all this stuff I've missed out on."
A few weekends ago, Jenna loaned Kendall some clothes and took her dancing at a 16-and-older club in Kent, where some guys taught her to merengue.
Though her self-confidence is growing, when boys look at her now, she still can't believe they are looking at her.
At her neighborhood Tully's recently, a cute 18-year-old barista who used to go to her high school did a double take. "Looking good," he said approvingly. The rush she felt wasn't from Frappuccino. It was the feeling of being 16 and having 100 pounds lifted off her shoulders.
Julia Sommerfeld: 206-464-2708 or firstname.lastname@example.org
Information in this article, originally published July 7, was corrected July 8. A previous version of this story incorrectly reported that Tacoma surgeon Myur Srikanth performed a gastric bypass on Josh Matthews nearly a decade ago. It was another surgeon in the same practice, Ross Fox, who performed the operation.
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