Archive for January, 2022

Adolescent Bariatric Surgery: Houston Surgeons Offer Solutions to Obesity Epidemic

January 13th, 2022

Close to five percent of U.S. children are severely obese. New research suggests that adolescent patients who have not succeeded with traditional weight-loss methods and have major co-morbid conditions may be good candidates for bariatric surgery.

The number of obese adolescents requesting bariatric surgery at the Houston UT MIST Center for Bariatric and Metabolic Surgery increases every year. This patient population often exhibits co-morbid conditions—type 2 diabetes,Guest Posting sleep apnea, fatty liver disease, high cholesterol, etc.—that we once observed primarily in adult patients. In response to this alarming trend, UT MIST offers adolescent bariatric surgery for severely obese adolescent patients who meet specific selection criteria. Our ultimate goal for these patients is early, safe intervention to reverse disease states and improve their overall health, wellness, and quality of life.

Effects of Childhood Obesity

The effects of excess weight on severely obese adolescents extend far beyond appearance and psychological well-being. For many, extra weight places an added strain on the body, leading to serious diseases that many overweight adults acquire later in life. Three major co-morbid, obesity-related conditions include the following:

Type 2 diabetes mellitus: The rise in the number of adolescents with type 2 diabetes corresponds with the overall rise in obesity among this patient population. According to a study published November 5, 2015, in the New England Journal of Medicine, three years following bariatric surgery, 95% of adolescent patients who began the study with type 2 diabetes experienced remission of the condition.
Obstructive sleep apnea: Many severely obese adolescents suffer from chronic obstructive sleep apnea (OSA), which causes them to stop breathing temporarily during sleep throughout the night. This can lead to hypoxemia, which is an abnormally low concentration of oxygen in the blood. OSA also causes fragmented and inadequate sleep, which is linked to a host of other physical and psychological concerns. Weight loss diminishes obstructive sleep apnea; in fact, some adolescent patients who undergo bariatric surgery experience complete resolution of the condition.
Hypertension: Obese adolescents often struggle with high blood pressure, once a concern mainly for older adults. Hypertension causes the heart and arteries to work harder than they should to move blood through the circulatory system. Over time, this can cause damage and lead to other health problems. Teens with high blood pressure who carry this condition into adulthood increase their likelihood of developing heart disease and stroke, two serious hypertension-related complications.
According to a study published in the February 2013 Canadian Journal of Surgery, “when the individual effects of bariatric surgery on obesity-related comorbidities are integrated, it results in a profound decrease in risk for coronary heart disease and overall mortality. In addition, given the low risk of surgery itself, bariatric surgery has become is a powerful treatment option to help control the obesity epidemic.”

Adolescent Bariatric Surgery Selection Criteria

At UT MIST, adolescent patients who satisfy the following strict selection criteria are considered eligible for weight-loss surgery:

Adolescents have a BMI of 35 or greater with major co-morbidities (diabetes mellitus, hypertension, sleep apnea, degenerative joint disease, asthma, and depression).
Patients have a BMI of 40 or greater with other co-morbidities (high cholesterol, glucose or insulin concerns, or poor quality of life).
Teens have been unsuccessful losing weight through a traditional, physician-supervised weight-loss program.
Adolescents have finished puberty, and they demonstrate emotional and psychological maturity required to comply with post-surgical care and eating requirements.
Bariatric Surgery Options for Adolescents

Because adolescent bariatric surgery is relatively new, there is insufficient scientific evidence regarding precisely which weight-loss procedure is optimal for this patient population. At UT MIST, safety and efficacy are our guiding criteria, so most of our board-certified surgeons who perform adolescent bariatric surgery favor either Laparoscopic LAP-BAND® Surgery (also known as laparoscopic adjustable gastric band surgery or gastric banding surgery), gastric sleeve surgery(also known as vertical sleeve gastrectomy or gastric sleeve resection surgery), or an endoscopic bariatric therapy such as the recently approved ORBERA™ Intragastric Balloon System. All of the these bariatric-surgery alternatives offer distinct advantages for adolescents:

LAP-BAND® Surgery: This laparoscopic outpatient procedure has a short recovery time and minimal scarring. The system is designed for long-term use and can be customized to each patient and adjusted as needed. It is also totally reversible.
Gastric Sleeve Surgery: This bariatric surgery option preserves much of the stomach so that the teen receives adequate nutrition from food consumed and does not need to rely on vitamins or nutritional supplements.
ORBERA™ Intragastric Balloon System: This procedure is performed endoscopically, requiring no surgery at all. The intragastric balloon is placed in the stomach and inflated, helping patients feel satiated after eating only small amounts of food. It can serve as an excellent, low-risk, short-term therapy to launch a comprehensive medical weight-loss plan, including dietary changes and exercise.
Risks from adolescent bariatric surgery are essentially the same as those that adults face, and the greater the BMI and number of co-morbidities, the greater the likelihood of complications following bariatric surgery. In every case, the surgeon, patient, and parents or guardians must determine whether potential risks are worth the benefits. Recent literature suggests that early surgical weight-loss intervention may reduce the operative risk because younger patients recover from major surgery more easily than older adults. In addition, early surgical intervention may halt the progression of other obesity-related disease states that could degrade a child’s quality and length of life.