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Can Weight Loss Surgery Save Our Children From Themselves?

December 30, 2008 8:56 AM

By DAN CHILDS, ABC News Medical Unit

ABC News' Lisa Stark reported today in a World News report and in a story on ABCNews.com that new research suggests severely obese teens with Type 2 diabetes may be able to benefit from weight loss surgery. The study unleashed a torrent of reactions from both the public in general and the medical community, and the ABC News Medical Unit received many comments from experts in baratric surgery and diabetes. Below is some of what they had to say.

A number of doctors told the Medical Unit that performing the operation on teens is a desperate measure for desperate times -- particularly as obesity rates in those age 12 to 19 approaches 18 percent, according to the Centers for Disease Control and Prevention. Study co-author Dr. Anita Courcoulas, chief of bariatric surgery at the University of Pittsburgh Medical Center, is concerned about the teen obesity problem:

“When we find that younger patients are experiencing what we used to think of as adult-type problems, it brings up the question of whether we can apply adult-type treatments,” Courcoulas said. “These are all children with a BMI over 50. These are really big, sick kids.”

New Jersey-based laparoscopic surgeon Dr. Alexander Abkin agreed:

“I, myself, offer teens both gastric bypass and gastric banding; it works great and it does reverse or cure Type 2 diabetes. ... If kids are denied care now, they will grow to be disillusioned about their future as adults, sick with medical problems, socially inadequate because of discrimination and so on. Surgery is one of the avenues to offer that hope.”

On the other side of the debate, physicians, like New York bariatric surgeon Dr. Mitch Roslin, warned that surgery may not be the magic bullet for which many have hoped:

“Having done this for 15 years, if there is weight regain -- and there is in many [gastric bypass] patients -- the diabetes can return. ... I think it is reasonable to aggressively treat young [diabetes] patients, since their internal or vascular age is greater than gestational age. [But] I am becoming more skeptical than many of my colleagues that [gastric bypass surgery] is [the] best operation.”

Dr. Francine Kaufman, head of the Center for Diabetes and Endocrinology at the Children’s Hospital in Los Angeles, concurred:

“This should not be viewed as license for any bariatric center to start looking at this procedure in teens; the procedure should be viewed still as experimental. The take-home message is one of caution. We have no long-term data, no idea what will happen with a dramatic permanent procedure such as gastric bypass ... that has to last 70 to 80 years or more.”

And Dr. Charles Clark, a professor at the Indiana University School of Medicine, said that prevention is the only sure-fire answer to the problem:

“I view with great concern the approach to the problem in the cited article. ... The expense and morbidity of the procedure makes it an unreasonable solution. The only solution to the childhood obesity epidemic will be more successful approaches to its prevention and treatment.”

December 30, 2008 | Permalink | User Comments (6)

User Comments

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Maybe if parents were more concerned about the size of thier children than the size of their house.

Posted by: jamescbuilder | Dec 30, 2008 10:04:26 AM

How about some personal responsability, if we had that along with pride in hard work, this wouldn't be the problem it is. It's pretty simple, don't eat more then you burn calorie wise in a day.
We have to stop being so PC and take charge of our lives.

Posted by: huh | Dec 30, 2008 10:25:20 AM

My son just had the gastric bypass and it wasnt because he was looking for a quick fix. He gained the weight he did because of continous steroid use for his severe asthma, plus he was in a wheelchair for months due to bilateral femoral surgery. Dont judge someone or their family until you have walked a step in their shoes. For those who dont agree with the surgery, do you take medication for an illness? have you had surgery to correct an illness. This surgery is not a quik fix, it is a tool to help get your life back. Think before you type, one day you may find yourself in my sons shoes.

Posted by: debbie pierle | Dec 30, 2008 12:08:39 PM

The parents should be arrested and thrown in jail, and the obese child removed from the home. Allowing a child to become obese is no different than assault with intent to kill.

The surgery is ridiculous. Whatever happened to wiring the jaw shut?

Posted by: tina | Dec 30, 2008 12:14:59 PM

Obesity is when excess body fat accumulates in one to where this overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as it is of a more serious concern. As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity. Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern.
Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline.
Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed. Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening.
One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine. Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has comorbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed.
There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are either gastric restrictive operations or malabsorptive operations. Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.
So the surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies.
Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.
If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: www.asmbs.org,

Dan Abshear

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Posted by: Dan | Jan 5, 2009 3:15:41 PM

I know that to some it may sound like a no brain r, just stop eating more than you can burn. However, it is not that easy for some of us. It is not fun being obese. Believe me, there is nothing that you can say that I haven't already thought about myself. I am ashamed of how large I have become. I definitely did not do this to myself on purpose. It seemed to happen gradually somehow... I can honestly see how someone that does not have food related issues would have a hard time understanding. I have a hard time understanding myself. All I can say to them is, you should thank God daily that you do not have to endure life as an obese person.

Posted by: Gina | Mar 2, 2009 11:33:41 PM

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