Weight-loss surgery for teens: a disturbing trend

We bloggers and readers been writing and talking amongst ourselves lately about children, weight, fat shaming, and concerns about policing and medicalizing kids’ bodies. Once you start down this path, it’s really hard to stop. And where does this lead? To increased health and fitness, an end to worries about body appearance and function and social acceptability? Not if you read the studies.

The recent news (and blog posts like this, this, and this) about Weight Watchers targeting children with their new teen diet programs has been a hot topic around here. I wrote here about what I don’t like about diets for children even when they’re informed by extensive research. In short, I don’t like weight loss programs that set up kids with possibly unattainable goals that also may not be necessary for them to live healthy and long lives.

But in the realm of kid weight problem concerns, nothing worries me like the increasing push to use both weight-loss drugs and bariatric surgery on children.

Let me repeat this last part: bariatric surgery on children.

What?

No, really, this is a thing now. Here’s Columbia University’s Center for Metabolic and Weight Loss Surgery’s take on age minimums:

Our consensus is that adolescence is really the boundary for performing weight loss surgery, and the World Health Organization defines adolescence as starting at age ten. However, aside from age, we look at other physiological factors such as sexual maturity and bone age growth when deciding whether or not bariatric surgery is appropriate in adolescents. With all these factors taken into consideration, the average age of adolescents undergoing surgery in our program is 16 years old.

Okay, ignoring the horrifying idea that a 10-year-old child is considered both an adolescent and potential candidate for this surgery, what’s so bad about this idea? That is, what makes this kind of surgery so worrisome for teens?

You asked (well I actually asked myself), so I deliver– here’s a short list:

Nutritional risks: teenage children are still developing, and weight loss surgery permanent compromises their ability to absorb nutrients. In particular, bone density and skeletal development may be (and have been shown in some studies) to be adversely affected. Deficiencies in levels of calcium, vitamin D, iron, B12, are common, so patients have to take supplements and be screened.

No real informed consent: in order to be able to perform any surgery, health care professionals are required to get informed consent from patients. This means explaining the nature of the procedure, possible and likely outcomes, side effects, and other important features of what life will be like afterwards. Teenagers are demonstrably not developed enough cognitively/neurologically to engage in long-term complex decision-making on this kind of scale. It seems to me grossly unfair to ask them to make such a life-changing decision at this point in their lives unless they are in extremis.

Pregnancy risks: yes, you read that right. In one study, the rate of pregnancy in a post-surgery cohort was twice that of the regular adolescent population. That’s not enough to conclude this with confidence, but it is enough for the American Society of Metabolic and Bariatric Surgery site to post this about that study:

This finding suggests that the risk of pregnancy in adolescents undergoing bariatric surgery might be increased. All female adolescents should be informed about increased fertility after weight loss and that pregnancy during the first 18 months after bariatric surgery has possible risks. These patients should be counseled to avoid pregnancy during this period and offered contraception.

In short, what are some things to worry about here? They are the usual worries about teenagers:

• Teenagers can be short-sighted and lack perspective about long-term effects of actions.
• Teenagers aren’t well-known for planning carefully against potential negative outcomes of actions.
• Teenagers don’t excel at being perfectly compliant with rigid dietary or other behavioral regimens imposed on them.
• Teenagers aren’t equipped to understand and process information to make the best decision about complex and emotionally fraught situations that they’re in the middle of.

That’s okay– this is part of what it means to be a teenager, and the rest of us are here to help them get through it. But putting them in a position to go through and deal with the outcomes from gastric bypass means exposing them to enormous risks and experiences they’re not equipped to handle and certainly will not want.

Tonight I’m going to this talk by a medical researcher who works with adolescents who get bariatric surgery. She’s going to talk about the complexity of weight and weight loss. I’ll report back later this week. Hope there’s a Q&A– I have a few questions for her…