Surgical Weight Loss Program for Teens

Because dieting and “medical” weight loss is so ineffective for the vast majority of teens who are extremely overweight, it has become increasingly important to consider how best to help them. What we know from adults who have had weight loss surgery is that surgery can cure morbid obesity. So, figuring out the best way to take care of these teenagers using surgery has been a major emphasis at Cincinnati Children’s Hospital Medical Center since 2001.  We like to believe that weight loss surgery can provide an early and effective tool for the patient to help prevent serious health problems.

Yes. The numbers show that 0.7 percent of weight loss surgery cases in the United States involve teenagers. But when you consider information collected from dozens of US hospitals, the rate of teenage obesity surgery has increased threefold over the past decade.  There have been more than 5,000 adolescent bariatric cases performed as of 2004. We believe that this rise in use of surgery is a realization that surgery does work for weight loss and that surgery can reverse significant health problems. 

Our Surgical Weight Loss Program for Teens and similar treatment programs at other hospitals have found that bariatric surgery can be a successful measure for improving hunger and fullness signals in patients with hypothalamic obesity. This allows the patient to get better control of the weight gain, and usually results in weight loss. In addition to the surgery, dedicated clinical staff teach patients how to best “listen” to new hunger and fullness cues from the new stomach, and take advantage of these, and how to become more metabolically “fit” after surgery, through good dietary choices and specific exercise training.

A Cincinnati Children’s was the first pediatric hospital in the world to set up a surgical treatment program specifically tailored to the needs of the extremely obese teenager. The program is called the Surgical Weight Loss Program for Teens. Since we started in 2001, we have performed more than 160 operations as of the  winter of 2011.  This is the largest amount of encounters at a single hospital in the world.

Yes. Our research has shown significant treatment results for diabetics. We knew that surgical weight loss  resulted in significant improvement in diabetes in adults. We carefully evaluated 11 teenagers with type 2 diabetes before and one year after they underwent Roux en Y gastric bypass. We looked at their weights, blood pressures,  blood chemistries and diabetes medication usage.  All but one of the teenagers who underwent gastric bypass had remission of diabetes (normal sugar levels without need for diabetic medications). Significant improvements in weight (loss of 34 percent), fasting blood glucose (41 percent improvement), fasting insulin concentrations (81 percent improvement) and hemoglobin A1C levels (7.3 percent to 5.6 percent) were also seen. There were also significant improvements in serum lipids (cholesterol) and blood pressure.

In comparison, we know that teens with type 2 diabetes, who do not undergo surgery, are highly likely to remain severely obese and are likely to see progression of their diabetes. We do feel as though extremely obese diabetic teens stand to benefit greatly from gastric bypass and can see significant weight loss and remission of type 2 diabetes due to the surgery.

 Yes.  In research that has been conducted in our sleep laboratory here at Cincinnati Children’s, we have made interesting and reassuring findings. It turns out that sleep and obesity are inter-related. Sleep duration and sleep quality (lack of fragmented sleep) most likely play a role in the development and progression of obesity and obesity-related health problems. So when we set out to determine the effect of weight loss on sleep quality in teenagers with severe obesity, this is what we found. First, we conducted a detailed look at sleep patterns by measuring brainwave activity during sleep and by measuring breathing during sleep in teens before and after weight loss surgery. These sleep studies were conducted in 19 patients with an average age of 16.5 years old who were about 200 percent over their ideal body weight. We found that three quarters of the patients had episodes of airway obstruction (obstructive sleep apnea) before surgery. At about one year after surgery, these patients had lost about 130 pounds on average. They also demonstrated a threefold improvement in sleep apnea. They had increased sleep quality and fewer unexpected awakenings from deep sleep.  This research shows that teens should expect a significant decrease in sleep apnea symptoms (mainly snoring and daytime sleepiness) as well as major improvements in sleep quality after surgical weight loss.

We stress to families that we don’t just offer an operation for weight loss.  We offer an entire program for weight loss, using the most effective, modern and safe procedures available. There are a lot of things we need to look at along the way to the operating room. Does the teen and Mom or Dad understand fundamental concepts about what causes weight gain and weight loss? Do they know what foods are nutritious and which are not? Are there things at home that will be challenges to the success of the teenage weight loss surgery patient? How is this treatment viewed by other family members? Is everyone on-board and willing to help the patient be successful? We would like to have some indication that the patient’s or family’s circumstances will not increase the risk of a poor outcome (weight regain, nutritional problems) if the surgery is done. Many of these issues are easy to address. Others may take more time.

To be considered for bariatric surgery, a teen must meet the following criteria (meeting these criteria does NOT necessarily mean that weight loss surgery is right for you):

• Body mass index (BMI) greater than or equal to 40 (generally more than 120 pounds over ideal weight) with obesity-related health problems (obstructive sleep apnea, diabetes, high blood pressure, significant quality of life or mobility problems).
• Inadequate weight loss with  organized weight loss attempts

There are many websites and publications that can be useful. Two websites that we recommend are The American Society of Bariatric Surgery and the American Obesity Association.

First we need your primary healthcare provider to complete the Bariatric Fast Track Referral form referring you for bariatric surgery, which includes:

• Your current height and weight
• A history of conditions being treated
• Diagnostic testing that has been done
• History of weight loss attempts

These records are reviewed by our clinical team to help determine if weight loss surgery may be an option for you.

Continue to adopt healthy eating patterns and develop an exercise routine. This will help surgical candidates prepare to be in the best physical condition for surgery.

Insurance coverage varies by plan.  Contact the customer service unit of your insurance carrier to determine what benefits your child has under your plan. We also have a family financial advocate to assist patients and their families.

It can take as little as three months or as long as one year, depending on the  time it takes to obtain insurance authorization, diagnostic testing, team evaluation and surgical scheduling. Each case is handled on an individual basis. Please contact us with questions specific to your child.

It is important that you learn all you can about obesity, nutrition and optimal weight management options. It is also very important for us to learn as much about your family’s specific situation to help guide you. It is our sincere hope that by following the Surgical Weight Loss Program for Teens Preoperative Timeline, a careful and informed decision can be made.

Surgery can take two to five hours depending on the individual and his or her health condition.

A hospital stay is usually three to five days for a laparoscopic procedure, but may be longer if open procedure is required. Some patients may be able to return to work or school in  one to two weeks, depending upon the amount of physical activity required. It may be extended on an individual basis.

Patients begin on a liquid diet. They progress to a pureed diet, then to a soft diet, then to a regular diet. These stages will be advanced in varying periods over the year following surgery, under close management by program dietitians and surgeons.