Bariatric + Pediatric = Bad Combination
Most of the overweight young people I see in the office have overweight or obese parents. Oftentimes, despite a child’s size and health issues or risks, many of these parents are in denial of the consequences of a do-nothing attitude, and they are resistant to acknowledging the role they played in their child’s obesity. Many wouldn’t have brought their child in if their pediatrician hadn’t intervened (and almost always pediatricians don't intervene soon enough!).
As obesity among young people continues to rise, these are the parents most likely to consider the option of weight loss surgery for their adolescents and teens. After all, if they didn’t want to do the work necessary to achieve their own slim weight in a healthy, habit-forming way, well . . . how can they do so for their kids? Here’s the hard truth: Kids don’t become obese on their own. Childhood obesity is a result of adult behavior. Parents create the environment in which their children grow. It's parents who don't want to shop for the right food, prepare it correctly, portion it appropriately, and feed it to their kids. Obese parents with a laissez faire attitude towards their own weight perpetuate that in their children. THAT is the issue, plain and simple.
It's becoming easier for these parents to hand their kids off to a surgical procedure. It's as if 'bariatric surgery' is on a check list right below 'pills, powdered drinks, packaged foods' and other quick-fixes that didn't work for their kids.
Yet, let's remember what bariatric operations, which fall into three categories, are:
- Restrictive procedures make the stomach smaller to limit the amount of food intake.
- Malabsorptive techniques reduce the amount of intestine that comes in contact with food so the body absorbs fewer calories.
- Combination operations employ both restriction and malabsorption.
. . . and all of them are about stopping the normal function of the digestive system. The more effective surgeries (like Gastric Bypass) actually disconnect or remove healthy organs. Removing healthy organs is not the solution to bad food or bad habits.
I have seen countless number of adults over the years who came to me after bariatric surgery didn’t turn out to be the invasive ‘magic fix’ they thought it would be and after they gained all their weight back.
I have seen several adults who traveled to Mexico for bariatric surgery because it was cheaper. When they had complications later on and couldn't find an American doctor who would “fix” another surgeon's procedure, they had to go back to Mexico for an additional procedure.
I have seen many adults who became depressed after surgery. They felt isolated in many social settings (parties, weddings, restaurants) either because they couldn’t partake as they used to or because they did, and ate too much. Then, they suffered the quick consequences of having to be in the rest room with pain, diarrhea, vomiting or acid reflux.
I have also had mothers, unsuccessful examples of their own bariatric procedures, candidly tell me they were waiting for their overweight teen to gain “just a little” more weight to meet a certain weight requirement in order to qualify for bariatric surgery! (Nothing like setting an example for one’s child, eh?)
Bariatric surgery is drastic, invasive surgery. Anything can happen . . . and often does, both physically as well as mentally. Therefore, consider:
- Are kids really both physically and emotionally mature enough to undergo the surgery?
- Are kids really able to understand they must follow a strict dietary regimen for the rest of their lives or they will regain the weight they lost—and more?
- Are kids really going to understand that if they try to eat too much there is a risk of follow-up surgeries because of ‘pouch dilation,’ when the stomach above the band becomes enlarged?
- Can a family with an obese mother or father (or both) really be able to provide the post-procedure support for their kid by setting an example of eating correctly?
- Does anyone really know the long-term effects of interfering with an adolescent’s or teen’s digestive system and nutrient intake?
- Are kids really able to understand that a lap-band is a human-made device that could be in place for a lifetime, and as such carries a risk of scarring and malfunction?
- Are kids really able to understand they will need to cultivate a new relationship with food by eating very small amounts, chewing thoroughly, and evenly spacing out food consumption throughout the day? Can they adjust to this way of eating and living without being overwhelmed? (I not too long ago had a conversation with a 20-year old woman who in addition to regaining half of what she had lost post-procedure, had recently had her band tightened and she told me it now takes an hour and a half to force down 2 scrambled eggs!)
- Are kids really able to understand that the requirement to be hyper-vigilant about what they eat, when and how, might make them stand out among their peers at a time in their lives when they want to fit in, and that being with friends or in other social settings can make it harder to make good nutritional choices?
- Are kids really able to understand that it will be hard for them to figure out a new, healthy relationship with food, especially if they and others in their family have always relied on food for comfort?
- Do kids have too high expectations? Do they think the surgery will boost their popularity or bring them more attention, and will they be disappointed and depressed to find that old problems still exist even at a smaller size?
ALL of the above goes to the heart of why, in my opinion, adolescents and teenagers are bad candidates for bariatric surgery: They are often immature, rebellious and uninterested in long-term consequences.
There are many unknowns when it comes to weight loss surgery for obesity in kids, including what the long-term effects might be on a their future growth and development. What's more, weight loss surgery does not guarantee that an adolescent or teen will lose all of his or her excess weight and/or keep it off long-term. It also doesn't replace the long-term need for a healthy diet and regular physical activity.
Weight loss surgery does not teach kids the lessons they need to learn in order to get slim and to stay slim and healthy all through adulthood. It is a quick fix that completely ignores the issues that cause these kids to become obese in the first place. It’s just another tool to set them up for a lifelong battle with their weight . . . and, for that, they’ll have their parents to thank for the rest of their lives.
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