Childhood and adolescent obesity is an epidemic in the United States. According to the Centers for Disease Control and Prevention, 17% of children and adolescents aged 2 to 19 (about 12.7 million children and adolescents) are obese. These children and teens are at higher risk for diseases that were once found mainly in adults, including:

• Diabetes
• Abnormal cholesterol
• Depression and low quality of life
• Liver disease
• Sleep apnea
• Menstrual problems
• Bone and joint problems
• Severe headaches due to pseudotumor cerebri (increasing fluid pressure in the brain)
• Severe non-alcoholic steatohepatitis (liver inflammation and scarring)
• Hypertension (high blood pressure)
• Insulin resistance/glucose intolerance/“pre-diabetes”

When should weight loss surgery be considered for an adolescent?

Weight loss surgeries for adolescents include the Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding. Weight loss surgery may be recommended if severe obesity poses a greater health threat to the adolescent than the potential risks of the surgery. The decision to have weight loss surgery should be made by the patient, the family and medical team after careful consideration of the potential risks and benefits.

Weight loss surgery is not for every teen who is obese. The long-term effects of this type of surgery are not known, and weight loss surgery does not guarantee that an adolescent will lose all of the excess weight and keep it off for a long time. Successfully keeping weight off after surgery requires a lifelong transformation in how one eats and a commitment to regular exercise.

According to guidelines from the American Society for Metabolic and Bariatric Surgery and other professional groups, adolescents who are considering weight loss surgery should:

• Have failed six or more months of organized attempts at weight management. (This should be determined with the help of a doctor.)
• Have reached or nearly reached physical maturity (age 14 or older for girls and age 15 or older for boys).
• Be severely obese, with a body mass index (BMI) of greater than 35 kg/m², with serious obesity-related problems; or have a BMI of greater than 40 kg/m² with other obesity-related problems.
• Be committed to comprehensive medical and psychological evaluations both before and after surgery.
• Agree to avoid pregnancy for at least 18 months after surgery. Adolescents may be at greater risk for pregnancy after bariatric surgery, so reliable contraception should be used. After the period of rapid weight loss is over, pregnancies should be carefully planned and monitored.
• Be capable of and willing to follow a strict bariatric diet after the operation. After gastric bypass surgery, patients must consume a very low-calorie, low-carbohydrate, high-protein diet. Daily multivitamins, as well as supplements of key nutrients such as calcium, vitamin B12, folate, thiamine and iron (for menstruating females), will also be needed for life.
• Consider and understand the risks of surgery and balance them with the potential benefits.
• Demonstrate the ability to make sound decisions. Age is not necessarily the limiting factor here.
• Have a supportive family environment.

Weight loss surgery is not an option for certain adolescents, including those who:

• Have a medically correctable cause of obesity.
• Have had a substance abuse problem within the preceding year.
• Are unable or unwilling to fully comprehend the surgery and its consequences. (This applies to the patient’s family, as well.)
• Are pregnant or plan to become pregnant within two years after surgery. Also, adolescents who are currently lactating (producing milk) after a recent pregnancy must wait to have the surgery.

How are patients for weight loss surgery chosen?

Along with a complete physical exam and counseling, your doctor will run several tests that can help determine if you are a good candidate for bariatric surgery. They include:

• Fasting glucose and hemoglobin A1C measurement to look for type 2 diabetes
• Liver function tests
• Blood cholesterol levels
• Complete blood counts
• Thyroid function tests
• Pregnancy tests
• Screening for nutrient deficiencies
• Sleep study (polysomnogram) to rule out obstructive sleep apnea
• Bone age x-ray assessment to document the degree of skeletal maturity

What happens after weight loss surgery?

Along with the physical recovery from surgery, adolescents need this time to get used to eating solid foods. During the recovery period, they have to slowly reintroduce solid foods, starting with a liquid diet, and then moving on to pureed food and finally, solids. Within four to six weeks, patients are eating solid food.

Patients have some physical restrictions during the recovery period, such as avoiding heavy lifting and gym class for about a month.

What are the risks of bariatric surgery for adolescents?

The long-term effects of bariatric surgery in teens are unknown. The early risks after surgery include dehydration, need for additional surgery, blood clots and death.

Pregnancy is also known risk factor after bariatric surgery for adolescent girls. An open discussion about birth control options should occur before surgery for every teenage girl considering a bariatric procedure.

What are the benefits of bariatric surgery for adolescents?

The benefits of bariatric surgery for adolescents include the following:

• Treatment for teenage type 2 diabetes: Teens who have type 2 diabetes and undergo weight loss surgery often have significant improvement (and sometimes complete elimination) of diabetes. After 3 years, 95% of teens who had type 2 diabetes before weight loss surgery remained in remission. (The long-term risk of the diabetes returning in these young people is not known.)
• Weight change: In one study, adolescent bariatric surgery patients had lost 26-28% of their body weight (about 80-90 pounds) on average. (Slightly more weight is lost with the gastric bypass procedure than with sleeve gastrectomy.) Many patients will continue to lose weight for years after surgery. Physical fitness and quality of life also improve after weight loss surgery.
• Liver disease: Obesity is associated with a buildup of fat called non-alcoholic fatty liver disease, which can lead to liver inflammation and scarring (non-alcoholic steatohepatitis). Weight loss surgery has been shown to significantly improve this condition in affected adolescents.

What is the long-term outlook for adolescents after weight loss surgery?

Weight loss surgery involves a deep commitment and intensive follow-through. Some teens may need body-contouring surgeries to get rid of the excess skin and flab that remain after massive weight loss. Teens who have had weight loss surgery must forever be careful about what they eat, when they eat and how they eat it. Long-term medical and psychological follow-up is also necessary after weight loss surgery.