The Big Picture: Young, Obese and in Surgery

Staff - nytimes.com - 01/09/2012
Obesity Surgeries

Though Shani Gofman had been teased for being fat since the fourth grade, she had learned to deal with it.

She was a B student and in the drama club at school. She had good friends and a boyfriend she had met through Facebook. She even showed off her curves in spandex leggings and snug shirts.

When her pediatrician, Dr. Senya Vayner, first mentioned weight-loss surgery, Ms. Gofman was 17, still living with her parents in Bensonhurst, Brooklyn, her bedroom decorated with glow-in-the-dark stars because she was afraid of the dark.

There was no question, at 5-foot-1 and more than 250 pounds, she was overweight. But she resisted, saying she could diet.

“I’ll lose weight,” Ms. Gofman assured her doctor.

Dr. Vayner said, prophetically, “It’s not your fault, but you’re not going to be able to do it.”

Along with the obesity epidemic in America has come an explosion in weight-loss surgery, with about 220,000 operations a year — a sevenfold leap in a decade, according to industry figures — costing more than $6 billion a year. And the newest frontier is young patients like Ms. Gofman, who allowed The New York Times to follow her for a year as she had the operation and then embarked on a quest to lose weight, navigating challenges to her morale, her self-image and her relationships with family members and friends.

But the long-term effectiveness of weight-loss surgery, particularly stomach banding, the procedure Ms. Gofman had, is still in question. And the push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.

“I think it’s pretty extreme to change the anatomy of a child when you haven’t even tackled the other elements,” said Dr. Wendy M. Scinta, a family practitioner in Manlius, a suburb of Syracuse, who specializes in pediatric weight loss. Unlike with older patients, she said, “there is not a huge rush to fix it or they will die.”

One percent to 2 percent of all weight-loss, or bariatric, operations are on patients under 21, but studies are under way to gauge the outcomes of surgery on children as young as 12. Allergan, the maker of the popular Lap-Band, a surgically inserted silicone band that constricts the stomach to make the patient feel full quickly, is seeking permission from the Food and Drug Administration to market it to patients as young as 14, four years younger than is now allowed. Hospitals across the country have opened bariatric centers for adolescents in recent years.

Doctors who are open to operating on younger patients note there is substantial evidence that dieting frequently fails.

“Most of us have witnessed the medical establishment provide the same advice over and over again to kids who are overweight — they just need to diet and play more outside,” said Dr. Thomas Inge, a professor of surgery and pediatrics at the University of Cincinnati, who is participating in a National Institutes of Health study of weight-loss surgery on teenagers. “I wish it were that simple.”

25 Minutes, and It’s Done

Ms. Gofman has been overweight for almost as long as she can remember. The boys on the school bus made fun of her. In school pictures, she never wanted to be shown sitting. “I wanted to be standing with people blocking me,” she said.

After her doctor proposed surgery, she tried to lose weight but failed miserably, gaining 30 pounds in eight months. Maybe, she said, she secretly wanted to qualify for “the easy way out.”

In December 2010, Ms. Gofman, who had just turned 19, and her mother arrived at the office of Dr. Danny Sherwinter, the wiry, fast-talking chief of bariatric surgery at Maimonides Medical Center in Brooklyn, for a consultation. Ms. Gofman was nervous but eager.

She had been sold on the Lap-Band, the only operation Dr. Sherwinter performs, because it is reversible and relatively low risk. She weighed in at 271 pounds, with a body mass index of 51, well above the minimum B.M.I. of 40, or 35 for people with at least one other related health problem, that was required for the use of the Lap-Band. (In February, the F.D.A. reduced the minimum B.M.I. for patients with another problem to 30, the threshold of obesity.)

Ms. Gofman’s mother asked what would happen if her daughter wanted to get pregnant. The band would be decompressed, Dr. Sherwinter said, and “basically you’re a normal pregnant woman, eating your pickles and ice cream.”

“Yummy,” Ms. Gofman said.

“What about the skin?” her mother, Judith, asked, meaning loose skin that might develop after weight loss.

“That’s going to be an incredible conversation,” Dr. Sherwinter said. “Let’s just get there first.”

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