Guide to Adolescent Weight Loss Surgery

As obesity rates increase among children and teens, weight loss surgery (also called bariatric surgery) has become an important treatment option for adolescents at risk of developing severe obesity-related disease.

Key Facts

  • Weight loss surgery may be appropriate for adolescents with a body mass index (BMI) of 40 or higher, or for teens with a BMI between 35 and 40 who also have significant associated illnesses like type 2 diabetes or high blood pressure
  • The most common type of weight loss procedures for adolescents are gastric bypass, gastric banding, and sleeve gastrectomy.
  • On average, adolescents who undergo weight loss surgery will lose 60 percent of their excess weight after one year.

Purpose

The purpose of adolescent weight loss surgery is to help teens find long-term treatment for obesity and reduce their risk of suffering from weight-related illnesses such as:

  • Cancer
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Obstructive sleep apnea
  • Stroke

Candidates for Surgery

In general, adolescent weight loss surgery is only performed when conventional weight-loss methods, such as diet and exercise, have been unsuccessful. Qualifying candidates include those whose weight has impacted their ability to function or whose weight, if left untreated, may lead to medical complications. In general, this refers to adolescents with a body mass index (BMI) of at least 40 and adolescents with a BMI of at least 35 who already have significant weight-related illnesses.

Evaluation

Even for teens who meet the BMI standards for bariatric surgery, further evaluation is done to make sure they have the physical and emotional maturity to handle the surgical experience and follow-up care.

Typically, the evaluation process begins at least six months before any surgery and includes the following:

  • Physical Examination: Candidates should have a BMI of 40 or above, or 35 and above with associated weight-related illnesses.
  • Weight Reduction Program: Candidates should complete a weight-loss program supervised by medical specialists (dieticians, physical therapists, and/or psychologists) and demonstrate that they are unable to show a healthy reduction of weight.
  • Sexual and Skeletal Maturity: Candidates should have reached pubertal maturity and achieved at least 95 percent of their adult height.
  • Psychological Evaluation: Candidates should demonstrate a clear understanding of the risks and benefits of surgery, show that they are capable of making an informed decision, and have realistic weight-loss expectations.

Procedures

There are three primary types of adolescent weight loss surgery:

  • Roux-en-Y gastric bypass
  • Laparoscopic sleeve gastrectomy
  • Adjustable gastric banding

Roux-en-Y Gastric Bypass

In this procedure, surgeon divide the stomach into two sections: a small pouch on top that continues to collect food as usual, and a larger section that is now bypassed and no longer used to digest food.

The following are the basic steps of this procedure:

  1. General anesthesia is administered prior to the surgery so that the patient is asleep and comfortable.
  2. Several small incisions are made and surgical tools are inserted inside.
  3. The surgeon staples off a large section of the stomach, creating a smaller pouch above it.
  4. The surgeon connects the small pouch to the small intestine, allowing food to bypass the larger stomach section.
  5. The larger stomach section is connected to the small intestines about 3 to 4 feet downstream, to allow digestive enzymes from this area to still mix with the food passing through the system.
  6. The incisions are closed and the patient is monitored for several hours afterward.

Gastric bypass has been used for treating adolescents since the 1970s.

Laparoscopic Sleeve Gastrectomy

In this procedure, the surgeon removes about 75 to 80 percent of the stomach. This results in the stomach taking on the shape of a tube or sleeve, which reduces food intake and encourages weight loss. While sleeve gastrectomy can be performed using traditional (large) incisions, laparoscopic sleeve gastrectomy involves inserting tiny instruments into several very small incisions.

The following are the basic steps of this procedure:

  1. General anesthesia is administered prior to the surgery so that the patient is asleep and comfortable.
  2. Several small incisions are made and surgical tools are inserted inside.
  3. The surgeon staples the stomach vertically in order to create a narrow sleeve, then removes the excess part of the stomach.
  4. The incisions are closed and the patient is monitored for several hours afterward.

The entire procedure typically takes about two hours. Sleeve gastrectomy has been performed more frequently in adolescent patients in recent years, with evidence of safe and effective results, but long-term data is still being gathered.

Laparoscopic Adjustable Gastric Banding

Less common than sleeve gastrectomy, gastric banding is another weight loss surgical procedure available for patients 18 and older. Instead of surgically removing a portion of the stomach, it uses a silicone implant to constrict the stomach and divide it into two separate compartments: a smaller one at the top and a larger one at the bottom. This helps limit food intake without affecting the normal digestion process.

The following are the basic steps of this procedure:

  1. General anesthesia is administered prior to the surgery so that the patient is asleep and comfortable.
  2. Several small incisions are made and surgical tools are inserted inside.
  3. The surgeon places the silicone band around the stomach, separating it into two compartments. This band is also connected to an injection port that is attached to the skin, making it easy to inflate or deflate the balloon inside the band.
  4. The incisions are closed and the patient is monitored for several hours afterward.

The entire procedure typically takes about one hour. Adjustable gastric banding is not yet FDA approved for patients under 18. There is evidence that it is safe and effective, but more research needs to be gathered.

Types of Doctors and Medical Specialists Involved

The following types of doctors are involved in the performance of adolescent weight loss surgery:

  • Bariatric Surgeon: This is a doctor trained and experienced in surgical procedures designed to help patients lose weight.
  • Anesthesiologist: This is a doctor who administers drugs to prevent and relieve pain during surgery.

The following are other medical specialists who may be involved in the surgical planning and follow up care:

  • Pediatrician
  • Clinical dietician
  • Endocrinologist
  • Nurse Practitioner
  • Psychologist

Alternatives

While diet, exercise, and other lifestyle changes are always recommended for healthy weight loss, these measures alone may not be enough for teens suffering from severe obesity. Adolescent weight loss surgery remains one of the only evidence-based treatments for severe obesity. 

For instance, a study by the American Academy of Pediatrics found that adolescents lost and kept off an average of about 30 percent of their weight over a period of five years or longer, significantly reducing weight-related illnesses such as hypertension (high blood pressure), diabetes, and elevated cholesterol.

Risks and Complications

Because bariatric procedures reduce the size of the stomach, patients may face the following complications and risks as they adjust to this change:

  • Difficulty Eating and Digesting: Eating too much or too fast can result in heartburn, diarrhea, nausea, and vomiting. Foods high in fat or sugar can worsen these symptoms.
  • Nutritional Deficiency: With part of the stomach removed, the body may not be able to absorb as many vitamins and nutrients as it once could.
  • Weight Gain: As patients get used to their new stomachs, they may not properly space out their meals. This can result in unintentional weight gain.

As with any surgery, there are additional risks that can occur. While less common, they include the following:

  • Anxiety
  • Bleeding
  • Blocked intestines
  • Blood clots
  • Depression
  • Gastroesophageal reflux (GERD)
  • Infection

Recovery

Immediately after surgery, patients will be monitored closely for any adverse reactions, such as bleeding or swelling. They will also get put on a non-sugar, non-carbonated liquid diet for at least a week as the stomach heals. This will eventually transition to pureed foods after about three weeks and finally regular foods after about a month. To supplement their nutrition during this time, patients will often have to take daily multivitamins and calcium supplements. They may also require a monthly vitamin B-12 injection for the rest of their life.

In the months following surgery, patients will be required to get frequent medical checkups to assess how well they are healing, monitor any digestive issues, and check the progress of their weight loss. Patients will also meet regularly with nutritionists and physical therapists in order to maintain a healthy diet and lifestyle. A year after surgery, patients should show significant weight loss.

Next Steps

Losing weight and keeping it off is a frustrating challenge for anyone, and especially difficult for children and teens navigating the additional complications of adolescence. Dedicated care centers like our Center for Adolescent Bariatric Surgery can help. The Center for Adolescent Bariatric Surgery is made up of a team of experts in pediatric gastroenterology, endocrinology, nutrition, mental health, bariatric surgery, and other specialties working together to deliver the highest level of care available.

For more information about the Center for Adolescent Bariatric Surgery, call our experts at (212) 305-8862 or request an appointment online.

Related