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Adolescent Bariatric Surgery: When Should You Refer?
Obesity’s prevalence in 12- to 19-year-olds has quadrupled in the last 30 years, with one in five adolescents now qualifying as obese. These adolescents are often ostracized and depressed, and they face a higher risk of serious health issues. Making matters worse, very few obese adolescents are able to change their diets or exercise habits.
In fact, obese adolescents almost always become obese adults. This significantly increases their risk of health complications – including diabetes, hypertension, sleep apnea, cancer, heart disease and stroke – and shortens their life expectancy. For many of these patients, bariatric surgery is their best shot at a longer, healthier life.
“Bariatric surgery can give them the best chance of improving their current health – and avoiding obesity-related issues later on,” says Faisal Ghulam Qureshi, M.D., Bariatric Surgeon at Children's Health℠ and Associate Professor at UT Southwestern. “We know that diet and exercise alone will not reverse weight gain once their BMI reaches 40. By performing weight loss surgery, we are able to change the body’s response to food and help patients reach a much healthier weight.”
Early Intervention is Key
Many pediatricians and primary care providers don’t know bariatric surgery is an option. We also don’t expect them to be familiar with the specifics of weight loss surgery or able to answer patients’ questions. That’s why we recommend providers refer patients to a bariatric adolescent surgeon for an initial conversation.
Dr. Qureshi encourages referring physicians to send not only their heaviest patients, but also those who are just reaching morbid obesity (BMI=/> 40), despite healthy diet and exercise implentation. Data shows that earlier referral leads to better outcomes. Waiting until children become super morbidly obese may not be in their best interest.
“If a patient starts at BMI 45, the operation can help them get down to a BMI of 30. These kids will see the maximum lifetime impact from surgery,” Dr. Qureshi says. “On the other hand, consider a patient whose BMI is 60. I can only bring him to a BMI of 45, maybe 42. He will be healthier, but he’ll still be classified as being obese.”
Who are Appropriate Candidates for Bariatric Surgery?
Patients are potential bariatric surgery candidates if they’re between 14 and 18 years of age and have a BMI of 40 or more, or 35 or more with serious obesity-related comorbidities.
At Children’s Health, we take a staged approach that begins with evaluating the patient and assessing whether they can make lifestyle changes that would make their surgery successful. The ideal surgery candidates meet these requirements:
- They’re at least 14 years of age and at Tanner developmental stage 4 or greater.
- They’ve tried to lose weight through diet and medical management for at least one year.
- They’re willing to complete a comprehensive pre-operative treatment plan and follow all program requirements with adequate family support.
“Only around 25 percent of patients referred to Children’s Health go on to have surgery,” Dr. Qureshi says. “Patients need to qualify not only from a medical perspective, but also from an emotional, psychological and family support perspective.”
Helping Patients Achieve Lasting Weight Loss
Teens who follow post-surgery guidelines usually lose more than 50 percent of their extra weight within 9 to 12 months. Guidelines include daily requirements of: limiting caloric intake to 800 calories, increasing protein intake to 60 grams of protein, drinking 60 ounces of water and completing at least 30 minutes of aerobic exercise.
“Our team closely monitors our patients for five years after surgery to help them reach their goals,” says Grayce O’Neill, the Bariatric Surgical Physician Assistant and Program Coordinator. “Patient compliance for the first six to 12 months after surgery is critical to their long-term success.”
We use the latest technology, including Bluetooth-enabled home monitoring kits, to monitor patients’ weight and dietary and exercise routines for the first six months. Patients appreciate the device because it offers a remote but steady connection to our team, while actively involving them in their own care.
We also partner with Children’s Health’s Center for Obesity and its Consequences in Health (COACH) Program, which offers personalized health coaching to all our patients.
For five years after their surgery, patients continue to meet with a registered dietitian, physician assistant and our endocrine medical team, if needed. They can continue to access services from our bariatric social worker and psychologist during the 5-year follow-up period.
“We understand the challenges these teens are up against,” Dr. Qureshi says. “That’s why we created a long-term follow-up program and a support system to help them reach their goals.”
Why Choose Children’s Health
Dr. Qureshi has trained in the latest, minimally invasive techniques and is the only trained pediatric bariatric surgeon in North Texas. He carefully reviews the expectations and outcomes of surgery with the patient and their families.
One of Dr. Qureshi’s recent patients, a 14-year-old girl, was 260 pounds at time of surgery. Six months after surgery, she had lost 45 percent of her extra weight, dropping her BMI from 42 to 32.
“When you see kids like that bounce back and start smiling again, you realize that every kid in their position deserves the best opportunity to get closer to a healthy weight, and to a happier life,” Dr. Qureshi says.