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CHoR Advancements: Adolescent Bariatric Surgery
Wednesday, October 30, 2013
The terms "overweight" and "obese" refer to serious medical conditions in which excess body fat accumulates to the extent that it may have an adverse effect on health. Obesity is measured by body mass index (BMI), a calculation using height and weight. BMI does not measure body fat directly, but is an indicator of body fat for most adolescents.
Being overweight or obese can cause an increase in many health related illnesses and contribute to a decrease in quality of life. Obesity puts adolescents at risk for:
- Elevated cholesterol
- Fatty liver disease
- Polycystic ovarian syndrome
- Pseudotumor cerebri
- Sleep apnea
- Type 2 diabetes
At the Children's Hospital of Richmond at VCU's (CHoR) Healthy Lifestyles Center (HLC), a team of dietitians, exercise specialists, psychologists, medical and surgical specialists, and nurses provide comprehensive lifestyle management for the treatment and prevention of obesity and weight-related medical conditions. Through specially designed multidisciplinary programs and services, team members work closely with adolescents and their families to promote healthy weight-management, eating, exercise and lifestyle habits with a focus on lifelong change.
Treatment options include:
- Behavior modification and support
- Increased physical activity
- Medical management
- Nutrition therapy
Adolescent Bariatric (Weight Loss) Surgery
Bariatric surgery may be considered as an adjunct treatment option for older adolescents with severe obesity and significant weight-related medical conditions. Bariatric surgery is a weight loss tool and adolescents must make lifelong changes to be successful.
Benefits of Adolescent Bariatric Surgery
Research shows that adolescent bariatric surgery is a more effective treatment for juvenile-onset morbid obesity compared to surgery delayed until adulthood.
Benefits also include improvements in:
- Gastroesophageal reflux
- Psychosocial function
- Quality of life
Surgery benefits can also include the reversal of weight-related illnesses including type 2 diabetes and cardiac abnormalities such as hypertension and high triglycerides.
Qualifying for Adolescent Bariatric Surgery
All surgery candidates must meet established criteria; participate in six months of medically supervised lifestyle intervention; and seek treatment for current depression, anxiety or eating disorders prior to surgery. Candidates must have a BMI >40 or >35 with severe comorbidities. It is also crucial that candidates for surgery be physically mature and understands the risks and benefits of surgery.Contraindications for surgery include:
- Active unstable liver disease
- Alcohol use
- Cardiac instability
- Clotting disorders
- Poorly controlled psychopathology
- Pregnancy (current)
- Smoking (current)
Laparoscopic sleeve gastrectomy: 80% of the stomach is removed. The remaining stomach is the shape of a tube or banana. Initial volume of the stomach is app. 2 oz.
Laparoscopic gastric plication: a portion of the stomach is rolled into itself and sutured to create a stomach tube. This reduces hunger and leads to weight loss as the amount of food that can be taken in at once is restricted. None of the stomach is removed.
What to Expect
- Extensive preoperative education is provided by a dietician -- including a diet plan and manual with step by step directions.
- Surgical patients must also commit to a liquid diet for two weeks before surgery and two weeks after surgery, gradually increasing to a regular diet with healthy lifestyle choices.
- The hospital stay after surgery is typically a few days.
- Initial food volumes will be less because of the stomach's size, but they will gradually increase over time.
- Bariatric surgery patients require lifelong follow up care.
Please call the Healthy Lifestyles Center at (804) 628-7337 (option 2) for an evaluation.