Gastric Action: 'Lap-band' surgery for teens gaining acceptance

Charlottesville, VA

Andrew Burrill says that the worst moment occurred last year in his high school cafeteria. Heading for a table, his tray laden with an extra portion of his favorite school lunch, Andrew was intercepted by a teacher who loudly asked, "Are you SURE you should have gotten doubles?" Andrew, who at the time was nearly 5 feet 4 and weighed 260 pounds, burst into tears.

"There were times when I felt I just couldn't go on," recalled Andrew, a sophomore, who lives near Charlottesville, Va. At 15, already a veteran of numerous failed diets, exercise programs and summer "fat" camp, Andrew became convinced that weight-loss surgery, which had transformed the physique of a family friend, was his only hope. He pleaded with his mother for help.

"I had to do this for him, no matter what," recalled his mother, Cheryl Burrill, an IT executive. But when she called hospitals around the country to find a surgeon who would reduce Andrew's stomach from the size of a large grapefruit to the size of an egg, she was told that he was too young and should come back when he turned 18.

Worried about his increasing girth, high blood pressure and severe sleep apnea, Cheryl Burrill said she didn't think her son could wait three years. Scouring the Internet, she found surgeon Eric Pinnar in Reston, Va., who specializes in "lap-band" surgery. Unlike gastric bypass, which involves stapling the stomach and permanently rerouting the intestines, lap-band surgery is reversible and involves the use of an adjustable band to bisect and shrink the stomach.

Last September, Andrew became Pinnar's youngest patient. Since then the surgeon has operated on four other youths under 18; more are planned.

These youths are part of a growing vanguard of extremely obese teenagers who are undergoing bariatric surgery, as the last-ditch weight-loss operations are known. The procedures, designed for those who are 100 pounds or more overweight, have increased dramatically among adults, from 14,000 in 1998 to nearly 178,000 in 2006.

Although a handful of doctors have operated on children and teenagers, some weighing more than 700 pounds, bariatric surgery has been regarded by many doctors as too risky and drastic for patients younger than 18. A 2007 study estimated that 2,744 teens underwent weight-loss surgery between 1996 and 2003, a number that more than tripled between 2000 and 2003. Many pediatricians and pediatric surgeons have been leery of the procedures, which have not been studied in children, require lifetime adherence to a strict dietary regimen, and can cause hazardous nutritional deficiencies and, in rare cases, death.

That opposition appears to be ebbing. Spurred by improvements in technique and studies in adults showing increased longevity and reversal of Type 2 diabetes and other problems, some influential opponents have softened their resistance. At the same time, the National Institutes of Health is financing a study of gastric bypass involving 200 teenagers, while the Food and Drug Administration is sponsoring a trial of the lap band in patients 14 to 17.

Skeptics say they are intrigued by the possibility that early intervention, before years of disordered eating and metabolic damage have taken their toll, might benefit some severely obese teenagers for whom other treatments have failed. Those hopes were buoyed by a small study published last month in the journal Pediatrics, which reported a resolution of Type 2 diabetes among 10 of 11 teenagers who underwent gastric bypass.

Two other factors are fueling the re-evaluation of weight-loss surgery: the relentless increase in childhood obesity and the dismal results of behavioral treatment, consisting of some combination of diet, talk therapy and exercise. Behavioral treatment has a long-term failure rate estimated at roughly 95 percent.

"We know that the vast majority of morbidly obese adolescents become morbidly obese adults and that medical and behavioral therapy doesn't work for them," said Evan Nadler, the director of New York University's minimally invasive pediatric-surgery program who is involved in the FDA lap-band study. "These kids are sick. This is truly a disease, a problem we can treat with the best means we know how. (Surgery) is the only known mechanism for sustained and significant weight loss."

Kurt D. Newman, the surgeon-in-chief at Children's National Medical Center in Washington, says that until recently he regarded weight-loss surgery as "kind of wrong -- more so in a kid." Prodded by his hospital's obesity specialists and faced with a growing number of 13 year olds weighing 300 pounds and a population that has one of the highest rates of pediatric obesity in the country, Newman has reconsidered. He is recruiting a bariatric surgeon for Children's new Obesity Institute.

David Ludwig, a pediatric endocrinologist at Boston's Children's Hospital and one of the nation's most prominent obesity experts, has also tempered his opposition. For carefully selected patients who have been treated consistently with other methods and failed, Ludwig said, surgery with appropriate safeguards may be an option. But, he warns, these operations are neither a solution to an urgent public-health problem nor a panacea. Bariatric surgery, he said, "can result in horrendous complications, require repeat surgeries and create a whole new set of medical problems.

Thomas Inge, the chairman of the NIH teen bypass study, directs the nation's oldest weight-loss surgery program, at Cincinnati Children's Hospital Medical Center. Since 2001, 110 adolescents have undergone surgery there, under guidelines issued by the American Academy of Pediatrics.

They must have a body mass index, or BMI, of at least 40 (the equivalent of someone who is 5 feet 4 and weighs 235 pounds) and a serious weight-related health problem such as Type 2 diabetes or high blood pressure. Referral by a pediatrician is required. Patients younger than 18 must have failed organized weight-loss attempts and have achieved most of their growth. All must demonstrate preoperative weight loss on a liquid diet and pass psychological screening tests.

The majority of Inge's patients are girls. One year after surgery, they had lost on average one-third of their excess weight, about 30 pounds for someone 100 pounds overweight, for example. Many remained obese but were no longer morbidly so.

Unlike gastric bypass, which is generally covered by insurance and costs about $25,000, lap-band surgery in teenagers is considered experimental, which means that parents typically must finance it.

To pay for Andrew Burrill's 45-minute procedure, his parents sold a vacation time-share.

Andrew, who has lost 52 pounds since the surgery and now weighs 184, said that the required changes in his diet have not been as difficult as he initially imagined. He said he does not miss the daily two-liter bottle of Mountain Dew he used to chug. And he has learned the hard way that if he eats too much -- more than about a half-cup of food at a time -- he vomits.

Adjusting to his dramatic weight loss has been somewhat tougher. Andrew, whose waist size has dropped from 44 to 34, said he still thinks that he looks enormous when he looks in the mirror.

The best thing has been the reactions of other people. "I haven't had one person stare at me since I got the surgery," he said. "And in PE, it's the first time in my life I don't come in last."

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Gastric bypass surgery resolves diabetes in teens

Los Angelos, CA

Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal Pediatrics.

Studies on adults with Type 2 diabetes show that gastric bypass can result in disease remission or better disease control. However, this study is the first to explore the effects of the surgery in children. The study examined adolescents with Type 2 diabetes, which is usually related to obesity and is being diagnosed with alarming frequency in American children and teenagers.

Dr. Thomas Inge, director of the Cincinnati Children's Surgical Weight Loss Program for Teens, studied 11 extremely obese teens with Type 2 diabetes who had gastric bypass surgery and 67 obese teens who were receiving medical management for Type 2 diabetes. Among the 11 teens who underwent surgery, all but one had a remission in diabetes. The response was so rapid, the patients often discontinued medication for diabetes control before leaving the hospital after surgery. These teens lost an average of 34% of their body weight one year after surgery. In contrast, the teens who were medically managed did not have any weight change after one year and were all still taking medication for diabetes. The adolescents who had surgery also had improvements in blood pressure, cholesterol and triglyceride levels.

"The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery," Inge said in a news release.

Inge and his co-authors noted that future studies will be needed to track the long-term health of teenagers who participated in the study. Cincinnati Children's Hospital is home to a study funded by the National Institutes of Health that will collect and report outcomes on 200 teens undergoing weight-loss surgery nationwide.

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Student will be first adolescent to have gastric bypass as part of UM Health System program

Ann Arbor, MI

She wants to shop for a prom dress, buy clothing at a regular mall store and walk easily across the stage on graduation day.

"I don't want to wheeze when I grab my diploma," said Sarah White, 16, of Vandercook Lake. "I don't want to graduate in a really large gown."

With more than 410 pounds on her 5-foot, 4-inch frame, the Vandercook Lake High School junior is desperate to lose the weight that for years has restricted her activities, drawn sneers from some classmates and compromised her health.
About gastric bypass surgery

The surgery changes the anatomy of a patient's digestive system to limit the amount of food that can be eaten and digested. It redirects food to bypass most of the stomach and flow directly into the middle of the small intestine, which limits calorie absorption. The surgeon uses staples to create a walnut-sized pouch at the top of the stomach that holds about an ounce of food and sews part of the small intestine directly onto the pouch. Risks include death, blood clots in the legs, leaking at the staple lines in the stomach and dumping syndrome, caused by stomach contents moving too quickly through the small intestine. The syndrome causes diarrhea, abdominal cramps, vomiting, sweating and dizziness.

— Source: Mayo Foundation for Medical Education and Research

She is scheduled to undergo gastric bypass surgery Tuesday at C.S. Mott Children's Hospital at the University of Michigan in Ann Arbor. White will be the first adolescent to have the weight-loss surgery as part of the UM Health System's new Pediatric Comprehensive Weight Management Center program.

"Her health is so significantly affected that surgery is warranted," said Dr. Susan Woolford, a university pediatrician and the center's medical director.

The university set up the family-focused program a year ago to combat the growing problem of childhood obesity. White entered in February 2007 when she was at her peak weight of 423 pounds, said her mother, Patricia White.

Sarah White revamped her diet and started exercising more, but did not lose much weight due to underlying health conditions, including a thyroid problem, Woolford said.

The surgery, which restructures the digestive tract and shrinks the stomach to limit the intake of food, is becoming increasingly common among teens as more struggle with obesity. But it still is not performed often, doctors said.

Some children's hospitals do not offer the surgery, and Woolford said she doesn't know of gastric bypass ever having been performed on an adolescent at UM.

According to medical literature, there are concerns about the long-term effects and the ability of pediatric patients to give informed consent to an invasive procedure that involves a lifetime of follow-up care and dietary restrictions.

"I had no other option," said White, who with support from her mother made the decision to go ahead with the procedure despite some early reservations.

"I was scared about all my intestines looking like a modern-day Picasso," she said Friday at the high school. She plays clarinet in the band, belongs to Students Against Destructive Decisions and said she has a 3.79 grade point average.

She had some qualms about the permanency of the surgery, "But it's either face up to eternity or die at 20," she said.

Fighting the weight

For years, White's weight-loss attempts have failed.

"I remember in elementary school, she bought salads and white milk or water when she bought lunch every day; that didn't work. She walked three miles a day and that didn't work," said her friend, Kelsey Weathers, 16, a diminutive girl who has been friends with White since kindergarten.

White once joined Weight Watchers with her grandmother, but said it seemed weird to be with a group of older women. She didn't lose weight, became frustrated and quit.

She weighed 6 pounds, 13 ounces at birth but quickly gained weight, developing faster than average children, her mother said.

Sometimes it is just easier and cheaper to eat at McDonald's than buy healthier foods, said Sarah White, who listed her weaknesses as Mexican food and pizza. At times, she struggled with emotional eating, but wasn't the type who raided the refrigerator at night, her mother said.

"Her body just doesn't metabolize the food," Patricia White said of her daughter, who was diagnosed at an early age with a type of hypothyroidism, meaning her thyroid gland doesn't produce enough of certain hormones, which impact metabolism.
By Dave Weatherwax | Jackson Citizen PatriotSarah White collapses her head on her mother's shoulder, Patricia White, after finishing her workout Friday afternoon at Planet Fitness of Jackson.

Both sides of her family have overweight members, said Patricia White, whose brother had gastric bypass surgery about two years ago. "She is genetically screwed."

Her daughter was obese by age 8, said White, a single, working mother who is both fiercely protective and proud of her daughter.

The two are clearly close and tease each other continually.

Friday, Patricia White razzed her daughter about her weight-induced spinal curvature, calling her Quasimodo.

"Well, he got the girl in the end, so there is hope for me," Sarah White countered, smiling.

Struggling with pain

The surgery is expected fix some of her problems, such as the curvature and the weight-related pain she feels in her back and knees.

At 8, Sarah White was diagnosed with type 2 diabetes and metabolic syndrome, a cluster of conditions that occur together and increase risk of heart disease, stroke and diabetes.

The excess weight has affected her self-esteem, her friends said. She regularly endures strangers' stares. It also makes school occasionally difficult.

Though White is witty, reads regularly and impresses friends with her vocabulary, her classmates haven't always been accepting, she said. "Especially in middle school, when everyone is discovering the opposite sex."

She cried often then.

Before she got involved with the program at UM Health System, which taught her to change some of the behaviors that contributed to her weight issues, she said she felt like a panda.

"All I did was sit around and eat and look cute," said White, who likes pandas and has many stuffed versions of them in her oriental-themed bedroom.

By the time she got to high school, things got better as the focus turned to academics.
More info

For more information about the University of Michigan's Pediatric Comprehensive Weight Management Center, visit www.med.umich.edu/MPOWER

"I've always been the smart fat kid, which is better than just being the fat kid," said White, who speaks openly and often comically about her situation.

"What I can't do physically, I make up mentally."

Her band director, Chip Williams, called her a "very good student."

"She is one of my top players," he said after class Friday.

However, White said she cannot both play her clarinet and march because it requires too much air and energy.

Her size keeps her from sitting at classroom desks. Instead, she sits at a table outside the rows other students fill.

For school dances, she has worn a purple pin-stripe suit. "It is hard to be girly in this body," she said.

A new chapter

She is looking forward to shopping for a prom dress after her surgery, which could help her lose 100 pounds by her birthday in January.

Her goal is to lose at least 200 pounds.

The surgery is about 90-percent successful in spurring and maintaining weight loss, said Dr. Henry Buchwald, professor of surgery at the University of Minnesota in Minneapolis, who has specialized in metabolic or bariatric surgery for decades.

The mortality rate in surgery is about 0.5 percent, he said.

Long-term effects of the operation on teens have not entirely been explored because the surgeries have been performed for about 20 years. But the procedures have held up over five-, 10- and 20-year periods, Buchwald said.

"What we hope we are doing for these adolescents is giving them time. Obesity is a fatal disease," Buchwald said.

The Tuesday surgery likely will keep White in the hospital for a week and a half, she said.

Her diet will be seriously limited in the weeks after surgery, as it has been in the weeks leading up to surgery.

For lunch Friday, she ate applesauce, a protein shake and yogurt, in compliance with a liquid diet she has been required to follow since Aug. 26.

To avoid temptation, all solid food has been removed from the house, Patricia White said.

After surgery, patients have to stay on course and maintain healthy life style habits to be successful, Woolford said. "Weight-loss surgery is not a magic bullet."

White has made the necessary changes, including incorporating physical activity into her weekly schedule, Woolford said, and has a strong family support structure.

She is rarely, if ever, negative, her friend Weathers said.

Some of the dietary restrictions have been difficult, Sarah and Patricia White said, but the payoff will be worth it.

"It's a small sacrifice to live longer," Patricia White said.

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Teens turning to gastric banding weight-loss surgery

Wilmington, DE

Gastric banding isn't just for adults anymore -- many young obese patients at Alfred I. duPont Hospital for Children have found the procedure a success.

For most of her young life, forgetting to eat was not something Nicole Herman ever worried about. She often woke up with hunger pangs so intense they made her nauseous.

But these days, Herman has to remind herself to grab breakfast. Otherwise, it may be the afternoon until she gets those familiar stabs in her stomach to signal her body needs food. That feeling of always being hungry is gone.

So is 77 pounds -- and counting -- from her 5-foot-3 frame. After spending most of her teen years trying to lose weight, Herman has finally found success by exercising, watching what she eats -- and by having a silicone band inserted around her stomach to restrict the amount of food she can eat.

The 19-year-old college sophomore is one of 11 teenage patients who have undergone gastric banding surgery at the Alfred I. duPont Hospital for Children in the last year. The hospital is one of four nationwide participating in a five-year study by the Food and Drug Administration to evaluate the safety and effectiveness of gastric banding, also known as LAP-BAND, in teens.

"I wanted to have it done because I've been overweight ever since I was little," said Herman, who lives in Middletown when she's not attending the University of South Carolina in Columbia. "I had it done in hopes of trying to lose weight and keep it off."

Of the patients who have had the gastric banding procedure at A.I. duPont -- including Herman -- all have had similar levels of success with weight loss, said Dr. Kurt Reichard, a pediatric surgeon who performs the minimally invasive procedure at the hospital. About 50 more children ages 14 to 17 are in some stage of preparation for the surgery.

Although the LAP-BAND can radically change the life of a morbidly obese teen, it's not for everyone, Reichard reminds prospective patients and their families. The actual surgery is only one aspect of a multidisciplinary weight-loss effort that also includes psychological counseling, fitness assessments and training with an exercise physiologist, and extensive education in food nutrition with a registered dietitian before and after the operation.

"It's about what the kids can do for themselves," said registered dietitian Michell Fullmer, who works with teens in the weight management program. "The LAP-BAND, it's not a magic bullet. It's a tool. I hope we give them what they need to use this tool well."

For Herman, it was the right tool at the right time. After years of yo-yo dieting and feeling frustrated by her lack of success, she was ready for the challenge. "I realized it would be a big life change, but I was ready," she said. "I realized I have enough self-discipline to make this work."
A national problem

Nationwide, more than 1 million teens -- about one in six -- are obese. The effects of carrying that extra weight are more than just bigger waistbands. Many obese children also have other health problems such as diabetes, high blood pressure, sleep apnea and even worn-out joints.

The majority of obese teens can lose the extra weight through a combination of diet and exercise. But when an obese person becomes more than 100 pounds overweight, they are considered morbidly obese, and for them, it's much harder to lose the weight through traditional means.

Fortunately for Herman, she never suffered from high blood pressure, diabetes or other associated health problems. She ate well and got regular exercise as a dancer. "I was a healthy fat person," she said.

But she also has Ehlers-Danlos syndrome, a connective-tissue disorder that affects the joints and makes them more prone to dislocation. She has undergone 12 surgeries to address tissue and joint problems. Her most recent was this summer on her right ankle.

While the Ehlers-Danlos isn't directly affected by her weight, the excess pounds put pressure on her joints. For that reason, any weight loss would help her.

Still, losing weight proved to be a challenge over the years. By the time Herman was 9, she was considered obese. The last time she and a friend could wear matching clothes was the fifth grade. Among her family, she was the only one with a weight problem.

As a teenager, Herman tried Weight Watchers, Jenny Craig and NutriSystem. Such diets worked in the beginning, but soon she got bored and hungry. "It was like a roller coaster," she said. "I think probably I got frustrated with not succeeding."
'Off-label' use in teens

Gastric banding was approved by the FDA in 2001 for use in adults. In teenagers, it's considered an "off-label" use, meaning the operation wasn't intended for that purpose. The FDA trial, in which duPont Hospital is participating, aims to discover if gastric banding can be an effective tool in helping morbidly obese teens shed the weight that threatens to shorten their lives.

In the cases where gastric banding may be an option for teens, their youth may actually be a benefit. "Although there's a perception that teenagers are noncompliant and uncooperative, I don't find that to be the case," Reichard said. "Kids are more open to lifestyle changes."

Health professionals don't know what kind of long-term effects await obese teenagers as they age, particularly if they have other health problems, Reichard said. That's why it's important for them to try to lose any amount of weight they can.

Earlier this summer, Morgan Stanley Children's Hospital of New York-Presbyterian released preliminary data showing that teens who underwent gastric banding had improvements in their obesity-related medical complications just six months after the operation. The six boys and eight girls in the study lost an average of 20 pounds and saw significant reductions in abdominal fat, triglyceride and blood-sugar levels. Their liver function also improved.

Some of the teens who saw improvements in their blood-sugar and cholesterol levels didn't have excessively high numbers to begin with, said Dr. Ilene Fennoy, a pediatric endocrinologist with New York-Presbyterian, which is also part of the FDA study. That their health data were already within a normal range and still improved reaffirms that weight loss has beneficial effects beyond dropping a few clothing sizes, she said.

More data are needed to fully understand the benefits of gastric banding in teens and what potential long-term effects may result, but so far the results are mirroring the success found in adults, said Fennoy, lead author of the study and clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons.

"This is early on but it's reassuring," said Fennoy, who presented the results in June to an annual meeting of the Endocrine Society in San Francisco. "It's showing we're already seeing changes in [symptoms of other ailments], even with not a huge amount of weight loss."
Making it work

In April 2007, after not finding success with any other weight-loss plans, Herman and her parents attended an informational meeting on gastric banding at A.I. duPont. She wasn't immediately sold. She was hesitant about having an operation to help her eat less, but the healthy eating and exercise components convinced her it could work if she believed in what she was doing. Her parents and friends pledged their support no matter the outcome.

"It helped that everyone was behind me on this," she said. "My family, especially my mom, has been so supportive of me."

Although her daughter has an outgoing personality, Sue Herman knew there were occasions where she felt singled out because of her size. She also she worried that her daughter's weight would impede her success in college and beyond.

"To watch her struggle was hard," she said.

When Nicole said she wanted to consider LAP-BAND, her mom went online and looked up information about the procedure. After extended discussions with the family's insurance company, which eventually agreed to cover the cost of the operation, they decided to pursue it.

Gastric banding works by making the stomach smaller. Unlike gastric bypass surgery, the stomach is not cut. Instead, a silicone band -- about the size of a shower curtain ring -- is inserted laparascopically around the top of the stomach. The band creates a small, egg-sized pouch for food consumption. It can be tightened or loosened by adding or removing saline solution into the band.

Compared with other weight-loss operations, gastric banding is less invasive. It also can be reversed, unlike gastric bypass surgery, which cannot. Still, like any operation, gastric banding carries some risks, including infection at the site of the incision. Gallstones also can occur in patients who undergo the surgery. Once the band is inserted, there is a small risk that it can slip out of place and cause pain and discomfort.

After the band is on, patients usually can eat only about 4 ounces of food at a time, far less than what they had been eating. Most of their meals are high in protein to prevent the loss of muscle mass. One of the first signs of not eating enough protein is hair loss, but later on, lost muscle mass from protein deficiency can effectively halt calorie loss.

Fullmer, the dietitian, holds monthly information meetings for prospective patients considering gastric banding. She said the first question asked is usually about the post-surgery diet.

"When I pull out a plate of what their diet is going to look like after surgery, I routinely get a gasp from the whole audience," she said. "It's sort of disbelief."

The first week after surgery, Herman was on an all-liquid diet while her swollen stomach adjusted to the band. She was still eating only liquids when she moved into her dorm. For the first months, she ate most of her meals in her room. She shared details of her surgery with only a few close friends.

Nowadays, a typical breakfast for Herman is a container of yogurt mixed with protein powder. Lunch may be a salad with half a piece of chicken. Dinner is a small portion of chicken or fish and vegetables. Post-surgery, she discovered she can no longer eat red meat, bread or rice because it upsets her digestion. She takes vitamin and calcium supplements to get enough nutrients and omega-3 fatty acids.

In addition to changing her diet, Herman has made exercise a priority. At school, the pre-med major fits in a workout no matter how crammed her schedule is, penciling it in as she would a class. The importance of working out was hammered in by exercise physiologist Lauren Falini, who tells patients exercise will not only help them lose weight but tone their bodies.

"Exercise is the other half of the equation," said Falini, who has patients keep track of their workouts with an exercise log. "It's about energy in and energy out."

The weight started disappearing rapidly within a month of Herman's surgery. By the time she stepped off the plane to visit her family in October, she was 40 pounds lighter. And she had already reached her first goal -- to fit in a size 18 pair of American Eagle jeans, something she had never done.

For Sue Herman, who hadn't seen her daughter since she left for college, the sight of her trimmer daughter was more than she expected.

"Beforehand I thought, 'What am I going to say if she's the same size? How am I going to inspire her to keep going?' " she said. "When I saw her, I couldn't stop looking at her."
A new person -- on the outside

Reichard attributes the early success of the gastric banding program to the extensive preparation the teens undergo before the procedure. Teens participating in the study spend about six months learning how to eat better, move their bodies more and understand the underlying emotional issues that may affect their success at keeping the weight off long term.

"We spend a huge amount of time getting to know them and their environments," he said. "It's the most important part of the program."

As part of the preparation, teens are expected to lose or maintain their weight before they have the gastric banding done. When the time comes for surgery, they must write a letter to the team requesting the procedure and laying out the reasons why they're a good candidate.

Working with the therapists in the weight management program, teens begin to realize the impact of the lifestyle changes they're incorporating, said Meredith Lutz Stehl, a clinical psychologist who works in the program. They begin to feel they have control over their weight, provided they follow the steps outlined by the weight management staff.

"It's such a crucial time to be able to get some hope, to believe they can feel like they can make some changes," Lutz Stehl said. "It's such a pivotal time for that, as opposed to people who have perhaps waited until their 20s or 30s to consider this."

In her letter, Herman spelled out some of the challenges in her path -- her Ehlers-Danlos, heading to college and adjusting to dorm life. But it's clear those are just small hurdles she intended to overcome.

"When I first heard about the LAP-BAND, I was a little skeptical and I wondered if it would really work and how hard it would be," she wrote. "You all changed that for me and made me believe that if I really want this as bad as I do, that I can work hard and get to where I want to be."

A year later, there's no denying Herman has changed from the 291-pound young woman who used to succumb to aching hunger pains. Now down eight pant sizes, she shops with friends at Old Navy and American Eagle, stores she bypassed on the way to plus-size clothier Lane Bryant. At her latest doctor's appointment this month, she weighed 214 pounds, down another 25 pounds from when she left school in May. She hopes to lose enough to wear a size 12 or 14 pants, about two sizes away.

Her megawatt smile is the same as it was before, but there's a new confidence that radiates from her, a self-assuredness strengthened by her weight-loss success. She feels healthy, strong, energized.

"Being overweight wasn't a big thing in my life. I've never wanted to be a size 2," she said. "I've always felt pretty good in my own skin."

But even she's surprised sometimes by the changes she sees.

"You catch a glimpse of yourself in the mirror, and you can't believe it's really you," she said.

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Gastric Bypass study at targets obese teens

Cincinnati, OH

It's arguably one of the most controversial weight loss options currently available -- gastric bypass surgery.

When it works, patients often lose hundreds of pounds that they would be hard pressed to get rid of in other ways.

When it doesn't work, it can lead to serious illness or death.
Click here to find out more!

Cincinnati Children's Hospital is one of five running a 10-year study of the procedure and its effectiveness on a segment of the population that often feels the brunt of weight shame -- teenagers.

"No one likes to see teenagers get to this point of this level of obesity that they can't go to school, they don't have friends," Dr. Meg Zeller said. "Their medical health resembles an adult's medical health, but the surgery and the weight loss that follows can alter that trajectory."

"We are seeing kids with average weight of nearly 400 pounds. The range is 250 to 650," Dr. Thomas Inge said.

Kylie Crovo said she can tell you about the benefits. She came to Children's Hospital at age 15 weighing 255 pounds. Now 17, she's lost 110 pounds in 18 months.

"It just feels great to live life not having to worry about any potential medical problems," she said.

Inge said he knows the procedure has its critics, especially when it involves teenagers.

"I think the average person who is hearing about weight loss surgery for teenagers and thinks, 'Oh my gosh, what are (they) thinking?' are not able to put themselves in the shoes of the people we are seeing," he said.

Amanda Munson has lost 100 pounds so far.

"The study means to me, basically I'm helping everyone else. We can give more information to other people," she said.

Doctors said they will follow all the patients over the next 10 years to study the long-term effects of the procedure.

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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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Gastric bypass a drastic solution but works for Florida teen

Deerfield Beach, FL

Haleigh Fenlon did not feel pretty and couldn't fit into cool clothes. Her parents worried about her aching knees, ankles and back, her lethargy, and the risk of future disease.

In August, her family and doctors made a controversial decision: The 242-pound, 5-foot-1 Deerfield Beach student had gastric bypass surgery. She was 16.

Today, Haleigh is 80 pounds lighter. Now 17, she said she feels great, has had no side effects and is marching toward her goal weight of 120.

"It's the best thing I've done," said Haleigh, who is getting her high school diploma online and working part-time. "I did it for vanity reasons. I didn't want to be deprived of life. I would not settle for fat-girl clothes."

With her surgically reduced stomach, she lives on 800 calories a day — less than half of a typical teen girl's diet — eating mini-portions of chicken, cheese, eggs and vegetables.

Gastric bypass for those younger than 18 is rare and controversial. Few bariatric surgeons take children, saying surgery is a last resort to be used only after exhausting all other avenues of weight loss. Others say teens may choose surgery for wrong reasons, such as peer pressure, and may lack the maturity to undertake the disciplined post-surgery lifestyle.

No studies have been done to show the effects of a highly restricted diet over many years, but clinical trials researching those issues are in the works. A record 1,000 teens had bypass surgery last year.

"We had reservations because she was so young," said Haleigh's stepfather, George Dupont, "but it has turned out well so far." More >>

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Teens having gastric bypass surgery and lap band procedure to lose weight

Chicago, IL

On yesterday’s ‘Oprah’ TV show we got to see teens that underwent either lapband or gastric bypass surgery in order to lose weight. Gastric Bypass and lapband procedure are similar in that they goal is to reduce the size of their stomachs to lose weight. The lapband procedure is more reversible in that they do not create a smaller stomach; they use a band to constrict the flow of food. Gastric bypass is a permanent procedure that the surgeons create a smaller stomach.

One teenager underwent lapband surgery in Tijuana Mexico at the age of 13. The mother said that she would have done it in the US, but nobody would do this procedure for someone this young. The daughter seemed to be happy with the results and has trimmed down. More >>

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Teen Opts for Gastric Bypass Surgery

New York, NY

Girl, 17, discusses long battle with obesity and decision to gastric bypass surgery.

When she was in the third grade, Amanda Baron bent the scales at 200 pounds, and in the next eight years she did everything she could to lose weight – personal trainers, fat camps, diets. Finally, at the age of just 17 and with her weight pushing 250 pounds, she underwent bariatric surgery (gastric bypass surgery) to reduce the effective size of her stomach. more >>

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The Bariatric Surgery Conundrum

November 18, 2007 - New York Times

This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese.

Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.”

Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ’70s and early ’80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.”

Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some circumstances — one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on — the overall mortality rate is now in the neighborhood of 1 percent.

But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications — physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000.

But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut — in fact, Bessler does consult for companies in the industry — the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced “complete resolution” of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea. From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions. That’s why some insurance companies cover bariatric surgery — as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about?

On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.” More >>

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Teens Share Gastric Bypass Experience

Teens Share Gastric Bypass Experience

A 16-year-old John's Island girl who's captured the attention of the community is resting in the hospital.

The teenager had a gastric bypass operation Wednesday afternoon and even perfect strangers showed up for support.

Friends and family, along with people they didn't know, came to support 16-year-old Alexis Khan, wishing her well before her gastric bypass surgery.

Another South Carolina teenager drove over three hours just to be with Alexis to ease any anxious moments before surgery. Brittany Henson and Alexis have much in common, at the same age and the same weight, Brittany had a gastric bypass. Now at 18, she is 125 pounds slimmer. More >>

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Gastric Bypass Surgery for Teens: How Young is too Young

Tackling Teen Obesity With Surgery: How Young Is Too Young?
Debi Chard, Live 5 News
Teens are tipping the scales. There's an epidemic of kids who are so heavy they face serious adult health problems.

In two days, Alexis Khan will undergo surgery to help her lose weight.
"We've tried every diet under the sun," says her mother. So Alexis is trying something much different, a gastric bypass. Because she's only 16 years old, having major surgery is not a decision she can make on her own. More >>

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