How We Evaluate Young Adults Considering Bariatric Surgery

Nearly 200,000 people get bariatric surgery each year in the United States, and about 1,000 of them are teenagers. The obesity rate among adolescents age 12 to 19 more than doubled between 1988 and 2014.

Even more unsettling is the increase of extreme obesity among these young adults, which is defined as a body mass index (BMI) at or above 120 percent of the sex-specific 95th percentile on the Centers for Disease Control and Prevention’s BMI-for-age growth charts. Extreme obesity rates in those age 12 to 19 rose from 2.6 percent in 1988-1994 to 9.1 percent in 2013-2014.

Obesity is linked to a variety of chronic health conditions that used to strike adults only: diabetes, high cholesterol, high blood pressure, sleep apnea, and bone and joint problems, among others. More and more young people are developing these ailments, and if they don’t already have them, they certainly are at increased risk for developing them in the future.

It’s in the best interest of our younger generations to gain control of their weight, and sooner rather than later. For some of them, making changes in their diet and physical activity is enough. But for many, it isn’t. As a result, more young people are considering bariatric surgery.

Bariatric surgery considerations for teens

Bariatric surgery isn’t for everyone, and there are some additional factors to take into account for a young person. But for some, it may be a good option to help them lose weight and improve their current and future health. One of these young adults—and a patient of mine—is 18-year-old Jewel Francis-Aburime, who shared her story about having weight loss surgery in spring 2017. She has some sage advice for people her age who are in a similar situation.

Jewel isn’t the first teen we’ve worked with, and she won’t be the last. But that doesn’t mean every obese teen should have bariatric surgery. It’s not a magic bullet, and it’s not an “easy way out.” If you’re not motivated and fully committed to making permanent lifestyle changes, you won’t get the results you want, no matter your age.

When working with teens and young adults, we must take into consideration whether they have finished growing. The nutritional impact of weight loss surgery can be substantial, and we don’t want to hinder growth.

There are certain surgical approaches we can take, such as the sleeve gastrectomy that doesn’t cause malabsorption, a condition that prevents absorption of nutrients. Talk to your doctor about the best options for you or your loved one.

Bariatric surgery is not for the slightly overweight, and it’s not done purely for cosmetic reasons. We follow National Institutes for Health guidelines to determine who is eligible for bariatric surgery. Potential candidates must:

• Be 100 pounds higher than ideal weight, or have a BMI of more than 40
• Have a BMI between 35 and 40 with conditions, such as high blood pressure, sleep apnea, heart disease or diabetes
• Have tried to lose weight through medically supervised diet plans, exercise and behavioral modification programs without success

Read and watch: Learn more about Jewel’s bariatric surgery journey in the Vox story.

Evaluating maturity, not age

When it comes to teens and bariatric surgery, age is just a number. The important thing is that they are mature enough to understand what they’re signing up for, the potential benefits and the lifetime commitment they’ll need to make for the surgery to be successful. I’ve met 40-year-olds who aren’t ready for this!

We spend months getting to know our patients before surgery to make sure they are truly prepared for surgery and life following it. Insurance companies require all patients to have a psychological or psychiatric evaluation before having bariatric surgery. These specialists can assess a whether they have an eating disorder or another behavioral or mental health issue we need to address before going ahead with surgery.

Everyone who has bariatric surgery needs the support of family, friends and healthcare team. Our psychology and psychiatry team also assess a person’s family support structures. Jewel was lucky enough to go through the process with her mother, who had surgery a month before her. This actually isn’t that uncommon. We often see husbands and wives or siblings who decide to have surgery around the same time.

While it can be helpful to have someone who knows exactly what you are going through, it’s not absolutely necessary. Having a loved one who will attend appointments with you or a roommate who will encourage healthy diet choices and join you for a walk can be just as vital to your success.

Committing to lifestyle changes during adolescence

As we transition from childhood to adulthood, we begin to learn who we are and how the world perceives us. We gain new freedoms, but also new responsibilities.

When you have bariatric surgery, you must accommodate a whole new set of lifestyle changes. Breaking old habits and building a healthy relationship with food and exercise is a difficult task at any age. Even more so when you are learning to make your own meals; selecting food in a college cafeteria; and trying to fit physical activity into a hectic school, work and social schedule. It can feel overwhelming at times, but you’re not alone.

I mentioned we spend months getting to know our patients and preparing them for surgery, and that relationship continues long after surgery. Follow-up care is a critical component to success. Psychological support is available along with continuing to meet with your surgeon and dietitian. We also offer monthly support groups where you can meet other people who have had bariatric surgery, discuss challenges and successes you’ve had and learn from others’ experiences.

While there are limited data on the long-term impacts of bariatric surgery in young adults, we do know the long-term risks of obesity. I would rather treat a young person now than wait 10 years or more when they’ve gained another 100 pounds and are diabetic or sick with heart disease.

Locations

MedStar Washington Hospital Center (Washington, D.C.,)
MedStar Montgomery Medical Center (Olney, MD)
MedStar St. Mary's Hospital (Leonardtown, MD)
MedStar Health at Brandywine (Brandywine, MD)