Originally created 11/07/02

Bariatric surgery emerges as drastic remedy for obese kids



CHICAGO -- Drastic surgery for obesity, once viewed as suitable only for adults, is emerging as an option for children, a new pediatrics report says.

Whether gastric bypass surgery, which shrinks the stomach from the size of a football to the size of an egg, might have long-term side effects for youngsters is unknown. But with childhood obesity reaching pandemic proportions, some families and their doctors see it as the only effective solution.

Researchers also haven't determined what age and weight a youngster should be before surgery, or whether the surgery, which can result in nutritional deficiencies in adults, could interfere with a child's use of bone-building calcium, said authors of a report in November's issue of Pediatrics.

Youngsters in one recent study who underwent gastric bypass were 15 to 17 years old, a time when peak bone mass is occurring, said the authors, Dr. Sue Y.S. Kimm of the University of Pittsburgh and researcher Eva Obarzanek of the National Heart, Lung and Blood Institute.

Because childhood obesity is so pervasive - about 15 percent of youngsters are severely overweight or obese - more research "is urgently needed," they said.

Doctors say demand is strong, bolstered in part by famous patients like pop singer Carnie Wilson, who dropped from about 300 pounds to 148 after an Internet-broadcast surgery in 1999, at age 31.

Most of the more than 100,000 people who are likely to have the surgery this year are adults, said Dr. Walter Pories, president of the American Society for Bariatric Surgery. He has no exact figures on how many children have undergone obesity surgery, but in an informal survey of 600 group members earlier this year, about 10 said they had done surgeries on children, all with positive results.

Some doctors cringe at the thought of subjecting youngsters to elective surgery that's so extreme.

"People change their habits. Doing something in the first 20 years that can affect you for the next 50 years ... ethically it's very hard to justify that," said Dr. Timothy Sentongo, a gastrointestinal specialist at Chicago's Children's Memorial Hospital.

For some children who have exercised and dieted to no avail, surgery is the only alternative, said Dr. Henry Buchwald, a University of Minnesota surgeon who has done obesity operations on 18 youngsters under age 18.

"Their life is turned around from being ridiculed at school to living a normal child's life," he said.

Ideally, patients should have achieved their maximum growth, said Buchwald, though his youngest was a 13-year-old who was about 150 pounds overweight.

Families should be told about surgery consequences, which may include malnutrition and gallstones.

"They're going to have to restrict their eating behavior or they'll just vomit and be uncomfortable," he said.

Ohio teenager Courtney Dunham says the risks were worth it. The high school senior says she has been teased since kindergarten, when a classmate said she triggered earthquakes when she walked.

Before her Aug. 2 surgery, she weighed 329 pounds - at 5-feet-3-inches, nearly 200 pounds overweight. So far she's shed 40 pounds, with no side effects. Her goal is to fit into size 16 jeans.

"It was a pretty big step, but ... it was the right thing to do," she said.

Her family is prone to obesity and associated ailments like diabetes and heart disease, and Courtney knew she was pushing her luck.

The doctors assured her that her biggest concern - that surgery might rule out eventual motherhood - was unfounded. So shortly after her 18th birthday, she underwent a 2 1/2 -hour gastric bypass, the most common type of bariatric surgery, in which a small stomach pouch is created by stitching the stomach's upper portion closed.

The intestine is redirected to attach to the pouch and to bypass a portion of the small intestine that normally absorbs nutrients. The operation results in weight loss by reducing food intake and nutrient absorption.

Courtney is now required to eat no more than a cup of food a few times daily, but must avoid sugar, which can cause symptoms including nausea, rapid heartbeat and stomach bleeding after the surgery.

Dr. Victor Garcia, who runs the program with Dr. Thomas Inge, has done similar operations on about six youngsters; four more are scheduled for surgery this month.

Not every obese youngster is a candidate, Garcia said.

"We have refused a number of patients for whom we felt the family would not be supportive," he said. "It's challenging because most parents are overweight along with the child."

Pediatrics: http://www.pediatrics.org

American Society for Bariatric Surgery: http://www.asbs.org

Cincinnati Children's Hospital: http:www.chmcc.org