Becky's mother came into my office and started crying before the door closed behind her.
"I've done everything I can but my child just keeps getting bigger. She's bullied at school, cries herself to sleep every night and now she's been diagnosed with Type II Diabetes. Should she have weight loss surgery?"
Questions like this are becoming more common as childhood obesity increases and weight loss surgery becomes a more common procedure.
The statistics are sobering:
- Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.
- The percentage of children aged 6--11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12--19 years who were obese increased from 5% to nearly 21% over the same period.
- In 2012, more than one third of children and adolescents were overweight or obese.
- Almost 4 percent are at or above the 99th percentile for Body Mass Index, meaning that about 2.7 million U.S. children could be considered morbidly obese. That percentage jumps higher for boys, African-Americans and the poor.
The pain felt by obese children and their parents is real and heartbreaking. Although the itch to do something -- anything -- to help an obese child can be overwhelming, bariatric surgery should only be used after the parents and a team of physicians consisting of the surgeon, a pediatrician and/or internist, and a psychologist have agreed that it's the best option.
There are no hard and fast rules for which child is a candidate for bariatric surgery, and no article could possibly list all the factors and co-factors to be taken into account in making the decision. However, they fall into three basic categories: environmental, physiological and psychological.
Assessing the environmental factors requires a hard look at the reasons for the child's obesity; i.e. why she overweight?
Is she growing up in a family in which everyone is morbidly obese? Does the mother derive her self-worth from cooking, making the child feel guilty if the plate isn't scraped clean? Is there a genetic predisposition for obesity running in the family? Could the child's eating be related to an external factor such as molestation or abuse, either ongoing or at some time in the child's past?
The answers to questions like these may rule out weight loss surgery as an effective tool.
The entire nuclear family should submit to a rigorous evaluation by a psychologist with experience in childhood obesity. The therapist will be testing both the child's and the family's emotional fitness for the impact of the surgery.
What is the child's emotional maturity? Weight loss surgery isn't magic. It can provide initial weight loss, but losing enough and keeping it off will ultimately depend on lifelong behavior modification. Is the child willing to do that?
This includes not only the first few years of healthier eating and exercise, but vigilance for the rest of their lives. For example, gastric bypass surgery doesn't work well for people who drink and smoke too much. Although the twelve-year-old child might be compliant, will she still be compliant when she's seventeen-year-old young woman?
Is the family willing to make the changes necessary for the surgery to work? If the family won't support both verbally and by example a healthy diet and lifestyle, there's no way the child will be able to do it on her own, and failing will have enormous implications for the child's ability to lose weight at a later stage of life.
The surgery can have a major impact on the child's future physical development. A pediatrician or qualified internist should evaluate things like:
Are the growth plates closed and the bones fully calcified? If not, the surgery could cause premature closing and calcification.
Has the child gone through puberty? If not, what are their nutritional requirements, and can those requirements be met in the first months after surgery?
What is the general state of the child's health? For example, if you give a twelve year old diabetic child a gastric bypass operation, she's not going to absorb calcium as well, which could cause the bone plates to close early. The pediatrician, along with the rest of the medical team, has to weigh the risks and impact of the early closure against the health risks of the diabetes to determine which will be more harmful in the long run.
So, I had no immediate answer to give Becky's mother. Until a stringent evaluation is done of the Becky and her family's environmental, psychological and physiological characteristics, my answer has to be "I don't know."
Dr. Nick Nicholson
Dr. Nick Nicholson has a passion for helping people suffering from obesity. He has performed over 10,000 bariatric procedures and has been called upon by Johnson & Johnson and W.L. Gore & Associates, Inc. to instruct surgeons on the use of their products in bariatric surgery.
|This book was reviewed by M. Stevens-David on Feb 12, 2014 (See Book Reviews)|
Dr. Nicholson's clinic has been recognized as a Center of Excellence by the American Society of Metabolic and Bariatric Surgeons. He is board certified in general surgery, and the holder of various patents on medical devices. With a bachelor's degree from the University of Texas at Austin and a medical degree from the University of Texas Medical Branch at Galveston, he completed his residency at the University of Texas Southwestern hospital.
A true renaissance man, Dr. Nicholson enjoys cycling, reading, movies, and spending time with his family. He is a proud Parrothead and lives in Dallas, Texas with his wife, sons -- 8 and 11 -- and Goldendoodle, Dixie.
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