Weight Loss Surgery: Teen Version

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KEY POINTS

• Weight loss surgery for severe obesity may be done to help you lose weight when other treatments have not worked.
• Your healthcare provider will work closely with you to choose the best type of weight loss surgery for you.
• Ask your provider how long it will take to recover and how to take care of yourself at home.

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What is weight loss surgery for teens?

Weight loss surgery for severe obesity, when you are 13 through 17 years old, may be done to help you lose weight when other treatments have not worked. The aim of surgery is to change your stomach or intestines to limit the amount of food you can eat before you feel full. It is also called bariatric or metabolic surgery.

Severe obesity is defined as having a body mass index (BMI) of 40 or higher. BMI is a number that takes into account both your height and your weight. A BMI of 25 or more means that you are overweight. A BMI of 30 or more means that you have obesity. Severe obesity is when you have a BMI of more than 40, or of more than 35 when you have a serious health problem related to your weight.

Another measure of obesity in teens is being 120% to 140% of the upper weight for your height and gender. You may also have other serious health problems that add to the overall health risks of having severe obesity.

When is it used?

Severe obesity is a serious condition. It increases your risk for having poor health and major illnesses such as high cholesterol, diabetes or insulin resistance, heart disease, and others.

Usually weight loss surgery is done only if you have tried other treatments, including low-calorie diets and increased physical activity, but you have not lost enough weight or could not keep the weight off. Weight loss surgery may be done when:

• You have a BMI greater than 40, or are at least 140% of the upper weight for your height and gender.
• You have a BMI greater than 35, or are 120% to 140% of the upper weight for your height and gender, with a condition related to obesity that may include:
  • Type 2 diabetes, which usually starts in adults, but children and teens have it too
  • Insulin resistance, which means your body makes enough insulin, but the cells are not able to use it properly. Without insulin, glucose (sugar) in your blood can’t get into your cells to use for energy.
  • High blood pressure
  • High cholesterol
  • Sleep apnea, which means that you stop breathing many times while you sleep, or other sleep problems
  • Nonalcoholic fatty liver disease (NAFLD), which is caused by obesity, diabetes, high cholesterol, poor food choices, or other factors, and is not caused by drinking alcohol
  • Gastroesophageal reflux disease (GERD), which is when the contents of your stomach back up into your esophagus (food pipe) causing symptoms and long-term problems
  • Idiopathic intracranial hypertension (IIH) or pseudotumor cerebri, which is high pressure in the spaces around the brain and spinal cord that can cause headaches and problems with vision
  • Problems with the how the thighbone connects to the pelvis (slipped capital femoral epiphysis) or a problem with growth of the tibia, one of the lower leg bones (Blount disease)
• You plan to delay pregnancy for at least 18 months after the surgery if you are a female

Your surgery may be delayed if you have an infection in your gastrointestinal (GI) tract such as H. pylori, until it is successfully treated.

This surgery can help:

• Lower blood glucose levels
• Lower blood pressure and cholesterol levels
• Improve sleep apnea
• Decrease the workload on your heart
• Decrease problems with bones and joints

Before you can have weight loss surgery, you need to be ready to change your lifestyle. Your provider will recommend that you:

• Meet with a dietitian about changing the way you eat. For example, after surgery you need to make sure that you get the nutrients you need. You will be eating smaller amounts, drinking the amount of liquid advised by your provider, and eating slowly. You may also need to take protein and vitamin supplements.
• Follow a supervised meal plan before surgery to show that you are willing to make changes to improve your health.
• Quit using any tobacco products or e-cigarettes at least six weeks before surgery.
• Avoid any substance or alcohol use for at least one year before surgery.
• Get counseling and support before and after surgery. It’s a big change that will affect your mind and emotions, as well as your body. You need to understand that surgery doesn’t mean your weight loss is permanent. You will need to eat a variety of healthy foods and get regular physical activity, or you will likely gain back the weight.

There are many types of weight loss surgery. Your healthcare provider will work closely with you to choose the best type of surgery for you. Your provider will discuss how you will work with your healthcare team after surgery to get the best results.

How do I prepare for this procedure?

• Talk to your healthcare provider and to other people who have had the surgery. Knowing what to expect can help lessen anxiety about the surgery.
• This surgery may be done as an outpatient or inpatient procedure. This means that you may be able to go home the same day as your surgery, or you may be in the hospital for one or more days. Talk to your healthcare provider about where you will have your surgery.
• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure or when you leave the hospital. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Follow your provider's instructions about not smoking before and after the procedure. People who smoke may have more breathing problems during and after the procedure and heal more slowly. It’s best to quit 6 to 8 weeks before surgery.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if you are or think you may be pregnant or are breastfeeding.
• Follow any other instructions your healthcare provider gives you.
• Ask your healthcare provider about the benefits and risks of each type of surgery and which type would be best for your condition. Ask any other questions you have before the procedure. You should understand what your healthcare provider is going to do.
• Surgery done for cosmetic reasons may not be covered by insurance. Check with your health insurance provider about what procedures your insurance covers.

What happens during the procedure?

Before the procedure, you will be given a general anesthetic to keep you from feeling pain. General anesthesia relaxes your muscles and puts you into a deep sleep.

Weight loss surgery may be done in the following ways:

• Roux-en-Y gastric bypass surgery (RYGB): Much of the stomach, which is normally the size of a football, is stapled shut. A small pouch of stomach, about the size of an egg, is then connected to the small intestine.
• Sleeve gastrectomy (SG): Most of the stomach is removed, leaving a small tube of stomach, called a gastric sleeve, connected to the intestine as it was before the surgery.
• Gastric banding (LAP-BAND) may be used in some cases: A band is placed around the upper part of your stomach. A soft cap (port) connected to the band is placed under the skin near your stomach. Fluid can be injected or removed with a needle inserted through the port. The fluid tightens the band to control the size of the stomach and limit the amount of food you can eat at one time. Fluid can be removed to relax the band if necessary.

These procedures may be done in 2 ways:

• Laparoscopic surgery is done through several small cuts in the belly. A laparoscope is a lighted tube with a camera. Your provider can put the scope and tools into your belly through the small cuts. Most surgeries are done this way.
• Open surgery (with bigger cuts in the belly) may be needed if you have had belly surgery in the past or if you have certain medical problems.

What happens after the procedure?

Depending on which procedure you have, your meal plan may need to change in the following ways:

• You may need to eat very small servings. At first, eat just a few tablespoons at a time and then up to a little over half a cup by the end of a year. If you eat too much, you may vomit and gag on food, or injure the new stomach pouch. It may be hard to eat tough foods such as steak, or foods that are hard and crunchy such as apples or raw carrots.
• You may not be able to eat foods high in sugar because your body may not be able to digest it well. After some procedures, eating or drinking too fast, or eating too much fat or sugar can cause dumping syndrome. This means that you will have nausea, vomiting, diarrhea, dizziness, and sweating after eating. Dumping syndrome is usually not a problem if the gastric band procedure is used.
• You may need to keep track of what you eat to be sure you get enough protein.
• You may need to take protein, vitamin, and mineral supplements for the rest of your life.
• If you have a lap band, fluid can be injected or removed with a needle inserted through the port, or the band may need to be repaired, adjusted, or removed over time. The reasons may include:
  • Not feeling full after eating
  • Slow weight loss compared to your expected weight loss
  • Having heartburn, reflux, vomiting, or problems swallowing
  • Not tolerating the limited meal plan
  • Pregnancy
  • A serious illness
  • Planned surgery for something else
  • Chemotherapy
• You will need long-term follow-up care with your healthcare team for medical conditions such as diabetes and sleep apnea, and to monitor weight loss and nutrition. They can also help you with life changes as you become an adult. Keep all appointments for visits with your healthcare team and for tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• You may have an infection, bleeding, or blood clots.
• Other parts of your body may be injured during the procedure.
• You may tire of the very restricted eating, and you may gain some weight back.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.