Is weight-loss surgery appropriate for teens?

Staff - theglobeandmail.com - 06/21/2011
Obesity Surgeries

For Brittany Klein, trying on trendy clothes was “just heartbreaking.” Jeans usually wouldn't stretch past her thighs and shirts didn't cover her stomach. Instead of the latest styles, her closet was full of oversized sweatpants and hoodies.

The teenager tried dieting, but always regained lost pounds. Unwilling to face a future of being overweight, she turned to surgery.

“I didn't want to have to struggle with weight for the rest of my life. I was going through my teens being heavy and I was just tired of going through the ups and downs,” said the Alberta resident, whose 5-foot-9 frame used to weigh 208 pounds (94 kilograms) — obese, but far from morbidly so.

When she was 17, Ms. Klein had adjustable gastric band surgery.

A $16,000 procedure, it reduces stomach capacity with a silicone ring. Since her operation at a Toronto private clinic in April, she has lost 26 pounds and has “never been happier.”

Teenagers and young adults — including those who are not extremely obese — are increasingly seeking surgery to lose weight, a trend some see as evidence that people believe surgery is a quick and easy solution in an image-obsessed society, instead of a last resort.

“The magic bullet [perception] is definitely an issue. There is no magic bullet to a problem that has not arisen overnight,” said Glenn Berall, who runs a childhood obesity clinic at North York General Hospital in Toronto.

Indeed, the facility where Ms. Klein had her operation — which is one of a growing number of weight-loss clinics — says gastric banding can be done on people who are just 20 or more pounds overweight. However, the American Society for Bariatric Surgery and other organizations say weight-loss surgery should be considered only by the morbidly obese or those who are very obese and have serious health complications.

“If somebody is just a little overweight, they wouldn't fall into those criteria, so most surgeons would not agree to do the surgery,” said Jack Langer, chief of general surgery at the Hospital for Sick Children.

The use of gastric banding on teenagers is controversial. The U.S. Food and Drug Administration, which approved the procedure for adults in 2001, has not cleared it for Americans under 18. And no long-term studies have been done on adolescent patients, some of whom are still growing, Dr. Langer said.

“We don't have experience with kids so I don't think we can say whether it's safe for kids,” said Dr. Langer, who has performed gastric bypass surgery, an older, more invasive procedure. “We just have to wait for the evidence to come in.”

While Canadian statistics are not yet being kept on gastric banding, the number of gastric bypasses — an operation that makes the stomach smaller and allows food to bypass part of the small intestine — has jumped in recent years, according to the Canadian Institute for Health Information. In 2004-05, surgeons in Canadian hospitals performed 1,113 such operations — 196 of them on patients under 30 — up from 819 in 2001-02.

However, advocates of laparoscopic gastric banding promote it as low risk, a minimally invasive and reversible procedure that can help some of the rising ranks of overweight young Canadians take charge of their health. According to Statistics Canada, slightly more than a quarter of Canadians between 2 and 17 were overweight or obese in 2004, a figure that has almost doubled since the late 1970s.

“It's a very good control mechanism that changes the relationship between patient and food — like a barrier, like a policeman inside,” said Jacob Joffe, a Toronto surgeon who performs the operation.

Over the past few years, Dr. Joffe has seen an increasing number of teenaged patients, including Ms. Klein, at the private Toronto LaparoscopicBAND Centre, located in a Georgian mansion on a leafy street in the Yorkville neighbourhood. Dr. Joffe, who notes that surgeons in other countries also operate on adolescents, estimates he has performed the procedure on more than 20 teens as young as 16, including an American.

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