Sunday, May 18, 2008

Gastric bypass surgery for teens

Creve Coeur, IL
Obesity in Children
Researchers report 30 percent of children in the U.S. are overweight or obese. The excess weight increases the risk for a number of health problems. About 69 percent of obese children have one risk factor for cardiovascular disease (like high blood pressure, high cholesterol or diabetes). 25 percent of obese children have two or more risk factors for cardiovascular disease. Overweight children are also at higher risk for developing asthma, back and joint pain, sleep apnea, depression and social stigmatization/isolation. In addition, overweight children often don’t lose the extra pounds and remain obese as adults.

Gastric Bypass for Weight Loss

In order to lose weight, a person must take in fewer calories and/or use up more calories in activity. Traditionally, that means eating a healthy, low-fat diet and getting more regular exercise.

Sometimes, diet and exercise aren’t enough. Obese patients who have failed traditional weight loss programs may be candidates for surgery. One surgical option for obesity is gastric bypass. Surgeons use staples to partition off the upper stomach into a very small section. Next, a cut is made into the lower intestine. Then the far end of the intestine is brought up to the new, scaled down stomach pouch. The procedure promotes weight loss in two ways. First, the size of the stomach is greatly reduced – limited to holding only a few ounces at a time. Thus, the patient becomes full very quickly. Second, the food goes directly from the new stomach section into the lower end of the intestine, bypassing most of the intestine and limiting the amount of calories that can be absorbed into the body.

Gastric Bypass for Teens

Traditionally, gastric bypass has been reserved for adults. However, more physicians are offering the treatment to obese teens. The National Institutes of Health says gastric bypass should only be offered for obese adolescents and teens who have tried to lose weight for at least six months and have not had success with traditional methods. Candidates need to have reached skeletal maturity (i.e., full adult height) and have weight-related health problems.

Carroll Harmon, M.D., a Pediatric Surgeon with the University of Alabama at Birmingham (UAB), says gastric bypass is not a procedure that should be taken lightly. Patients must be carefully selected and fully aware of the benefits, risks and permanent lifestyle changes associated with the treatment. Once the surgery is done, patients will initially be on a puree diet. After that, the amount of food that can be eaten at one meal is very small. Often a few bites will fill the stomach. Protein shakes are needed to ensure the teen gets enough protein and nutrients. Traditional teen foods, like hamburgers and french fries, need to be avoided. Sodas are discouraged because the carbonation makes the stomach feel full without getting any nutrients. So teens need to learn how to cope with the social consequences of their new food limitations. They must also understand the surgery requires a lifelong commitment to a change in dietary and lifestyle behaviors.

UAB's Center for Weight Management brings together a group of medical experts to help determine if gastric bypass is an appropriate option for a teen. Prior to selection, the teen must be on a medically supervised diet for at least six months. Several weeks before surgery, the teen is placed on the post-op diet and exercise program. The goal of this part of the treatment is to ensure the teen is comfortable with and will stick to the post-op diet and exercise requirements. Harmon says family members play a big role in ensuring the teen’s follow-through with long-term treatment. So patients must have a good family support system.

UAB is studying the safety and long-term effectiveness of gastric bypass for teens. The participants will be followed for five years. Other sites are located at Cincinnati Children’s Hospital, Texas Children’s Hospital and the University of Pittsburgh.

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