More teens are turning to weight-loss surgery

Staff - miamiherald.com - 08/14/2011
Obesity Surgeries

José Berrios loves basketball and the Miami Heat. But weighing in at 243 pounds prevented the 18-year-old from playing the game.

That was before he had bariatric surgery in January. Since then, he has lost 50 pounds and been a regular on the basketball court.

“My waist size used to be 42; I’ve gone down to 34,” he says. “I’ve had to change all my clothes. And now I can play basketball.”

His mother, Diana, encouraged him to have the surgery. Years ago, she had a gastric derivation performed by Dr. Anthony González, the medical director of South Miami Hospital’s weight-loss surgery program.

“I fought obesity as a child and still must watch what I eat and never stop exercising,” says González, who received his medical degree at the University of Miami in 1994 and completed his surgical training at Jackson Memorial Hospital. “I realized what it was to wrestle with 20 or 30 extra pounds, so I understood the effort of dealing with 130 extra pounds.”

The number of U.S. children considered obese has grown significantly since the 1980s, from 5.5percent of kids between 2 and 19 in 1980 to 17percent in 2008.

“Michelle Obama, for example, has sought support to help obese children. There are more than 8 million Americans with morbid obesity — at least 100 pounds overweight,” he says, adding that this causes 350,000 deaths every year.

“People suffering from severe obesity should get help, since there are options to help them. This can mean not only medical problems, but social and psychological, as well.”

González begins to evaluate children at age 14, but he does not believe surgery is necessary at that age. “It depends on the child, their psychological maturity and their bone maturity. The family structure is also important,” he says, and adds that treatment must begin at an early age since childhood obesity has long-term ramifications such as diabetes, high blood pressure and other cardiovascular issues.

González has performed bariatric surgery on teenagers sporadically for 10 years, but during the last year he has formalized the multidisciplinary program to deal with all aspects of teen obesity. “Not only surgery is important, but also eating habits, psychological issues and exercising.”

Dr. Samuel Szomstein, associate director of the Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery at Cleveland Clinic Florida, says they do not perform this type of surgery on teenagers until they have reached puberty and have finished growing. Besides, they must have the psychological maturity and family support to be able to handle such significant changes in their lifestyle.

“This is not cosmetic surgery,” Szomstein says. “Most of these teenagers are already showing disorders associated with obesity, such as diabetes, obstructive sleep apnea, hypercholesterolemia, depression, etc. We have to be sure that they are interested and have realistic expectations about the surgery — that they do not feel pushed to have it merely for the cosmetic or social benefits.”

Surgery is only a small part of the process, and a multidisciplinary approach is required to help these patients with the many changes that will happen in all aspects of their lives. “As their quality of life improves, so will their self-esteem,” he says.

But it isn’t just teenagers who benefit from this surgery. The doctor says he just received an email from a satisfied 40-year-old patient who now can jump in a parachute, fly and wear a swimsuit.

“Simple things for other people that she could not do, and now she can. It’s sad to see a woman with diabetes and high blood pressure at age 40, and those medical problems can also be resolved with bariatric surgery.’’

There are three different bariatric surgeries: adjustable gastric band, tubular gastrectomy (or sleeve gastrectomy) and gastric derivation.

The gastric derivation reduces the size of the stomach, and the digestive system is bypassed. The stomach is cut, a small bag the size of an egg is created, and the intestine is connected to that bag. When the patient eats, the food goes to the small bag and later moves to the small intestine. No food goes to the main stomach, which is why it’s called gastric derivation.

“This operation controls the amount of food that can be ingested,” González says. “The patient’s eating is restricted and has a poor absorption of food.” He adds that it is important to exercise.

The adjustable gastric band is placed around the top of the stomach and connected to a tube, thus reducing its capacity and restricting the ingestion of foods. This procedure is simpler but requires dedication on the part of the patient. For it to be successful, the patient must go to the hospital for adjustments, exercise and refrain from eating sweets.

“The patient must come to see me every month during the first year and once every two months during the second year. Afterward, only when necessary,” González says.

The sleeve gastrectomy removes a section of the stomach, creating a very thin stomach shaped like a banana, resulting in a reduction in the ingestion of food. “The patient’s commitment with this operation is not to eat sweets, because the sleeve does not control the absorption of sweets — and exercise,” he notes.

Depending on the type of operation and the patient, the weight loss will be different. With something as simple as the gastric band, a person can lose one pound a week or 50 pounds in a year. And something as complicated as a gastric derivation can help a person lose 275 pounds.

“Any surgery can be dangerous,” González says, “but the gastric band is a simple and sure surgery. Complications are very rare.”

The sleeve gastrectomy and the gastric derivation have more risks.

“The most complex surgery in the nation is the gastric derivation, and that operation has a mortality risk of 0.1 percent,” González says.

A person with a body mass index (BMI) of 30 or higher, or 100 pounds overweight, can choose any of these surgeries. The BMI is a calculator that measures weight in pounds and height in feet and inches. An individual with a BMI of 30 or greater falls into the category of morbid obesity.

Patients and doctors discuss the type of surgery that must be performed, depending on what the candidate wishes to accomplish. “Sometimes I agree with what the person wishes to do; other times, I don’t. I always tell them which option I consider best for them,” he says.

Recovery depends on the type of surgery. The band, which is the simplest, has a very quick recovery. The person can return to work or school in one or two days. It takes about a week with the sleeve and gastric derivation.

Elena Iglesias can be reached at elemaga at hotmail.com.

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