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Obesity Surgery in Children - Too Much – Too Soon! (page 2)

By — Obesity Prevention Special Edition Contributor
Updated on May 17, 2010

Problems with Gastric Bypass Surgery for Children

Thanks in part to the popular TV show “The Biggest Loser,” we all now know that weight loss can be achieved without surgery of any kind. It is a tragic indictment of our society that we can spend $10,000 - $40,000 cutting the stomachs and rearranging the intestines of our children, but we cannot spend one-tenth of that amount in diet and exercise programs to prevent and reverse this problem. As such, there are several reasons why I respectfully object to gastric bypass surgery for children:

  • While co-morbidities of obesity, such as type 2 diabetes and sleep apnea, are serious, children are not dying before the age of 18 solely from being overweight. Obesity surgery, however, carries a small but finite peri-operative mortality rate. Is it really justifiable for a precious child to lose his or her life undergoing experimental weight loss surgery?
  • We do not know the long-term consequences of having one’s stomach cut away from the flow of intestinal contents and then “parked” in the abdomen for potentially 60-80 years with no ability to access it via endoscopy. What are the potential complications of this down the road? Gastric cancers, ulcers, more?
  • We do know that the gastric bypass operation comes with several side effects, among them nutrient and calcium malabsorption, iron-deficiency anemia, bone density problems, and folate malabsorption, leading to an increased likelihood of birth defects in subsequent pregnancies. We also know that teens are notoriously non-compliant with parental recommendations to take vitamins (and most other advice from their parents!). Is it realistic to expect adolescents to take responsibility for managing these side effects, and are they prepared for the consequences of not doing so?
  • As minors, children and teenagers cannot legally consent to this permanently life-altering operation. Their parents do this for (to) them. Our clinical psychology colleagues inform us that the cognitive ability to understand death does not occur until approximately age 25. If child and adolescent obesity isn’t life threatening, shouldn’t these children have a chance to make the decision to undergo surgery for themselves when they are old enough to understand the risks and consequences of such a decision?
  • Lastly, there’s a good chance that obesity surgery may become obsolete in the near future. Given the feverish pace of drug company research into obesity and the rapid advances in understanding the neuro-endocrine-gastrointestinal contributors to appetite control, it is hard not to believe that a medical aid to weight loss will be developed in the next 5-10 years. What will we do with all these re-routed stomachs then?

Non-Surgical Alternatives

Obesity surgery for children is a problem of too much, too soon. We must seriously attack childhood obesity in the young (6-7 year olds) when we stand the best chance of changing behavior. We should enroll them in serious diet and exercise programs and, if necessary, take them out of school for 6 months or a year (as with a child with cancer or another serious illness) and spend time and money on treating this problem.

If all fails, gastric bypass surgery can be an option as an adult when the child has grown up, had their children, and most importantly, is more able to understand the life-long risks of mortality, cancer, adhesive bowel obstructions, internal hernias, flatulence, and other health consequences of obesity surgery and can give their own informed consent.

Parents and pediatricians are the gatekeepers and guardians of our youth. We all must think long and hard before recommending a “quick surgical fix” for a chronic behavioral problem. Long-term studies in adults suggest that even with gastric bypass surgery, weight loss may not sustain and weight often returns after 10 years. For a young patient with 50+ years to go, that is truly significant!

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