MOUND CITY, KAN. -- Terry Smethers weighed a
“very severely obese” 367 pounds when, at age 66 four years ago, he had the weight loss surgery that he says saved his life.
Concerned that his daughter, Lorie Boyd, would die of her own obesity — at age 45 and 286 pounds, she was diabetic, depressed and could barely walk without turning breathless — Smethers then plopped down $12,000 of his savings to pay for a surgery that would ultimately allow her to shed 120 pounds.
“It was like carrying around a whole other person,” Boyd said.
Then, about six months ago, the family made a decision that puts them at the forefront of a national obesity issue, one that remains controversial even as it becomes more common: surgery for Smethers’ teenage granddaughter.
Kayleena Boyd was then age 15 and 250 pounds.“I was miserable,” said Kayleena, now 16 and 70 pounds lighter after surgery.
“If I would have kept going on the path I was, in 20 or 30 years I probably wouldn’t have been here anymore.”With obesity in America at epidemic levels and the rate among children at 17 percent, triple what it was 30 years ago — the practice of bariatric, or weight loss, surgery for teens is also growing, with some patients as young as 12 or 13.
At root is a growing but cautious recognition among physicians that for some obese children, the surgery — which reduces the size of the stomach to a tiny pouch — not only improves their physical and emotional lives, but also may be the most effective way to change their size. Doctors across the county now report they are seeing children who, by age 10, are already too fat to lose weight in any lasting way through nutrition or exercise alone.
“In a nutshell, kids are getting sicker and kids are getting heavier,” said physician Sarah Hampl, medical director of the weight loss program at Children’s Mercy Hospital.
At least four private surgical weight loss practices in the Kansas City area have operated on teens. As recently as five years ago, Children’s Mercy did not envision doing weight loss surgery on children. Now, Hampl said, “it is an option we are seriously looking into.”
No one knows exactly how many teens are going under the knife.
Estimates put the number at 1,000 to several thousand a year, a tiny fraction of the 200,000 to 220,000 bariatric surgeries conducted last year in adults. Just as the nation’s weight has grown, bariatric surgery has ballooned into a $3 billion industry, quadrupling in the last decade and, according to the American Society for Metabolic and Bariatric Surgery, growing by 1,500 percent in the last 20 years.
In bariatric surgery, physicians use any one of several techniques that include gastric bypass, gastric banding or sleeve gastrectomy to surgically reduce the stomach, which can usually hold about a gallon, to one that holds as little as a cup.
The result is that patients feel full faster, eat less and lose weight at an accelerated rate.
With gastric bypass, fewer calories and nutrients are absorbed because the new, tiny stomach is attached to bypass part of the small intestine.
Adult patients laud the surgery for changing their lives, not just cosmetically — allowing them to lose 100 pounds or more — but also because it reduces many if not most of obesity’s life-threatening effects: heart disease, arthritis and diabetes.
“Before I got my surgery, I was on three different blood pressure medications, two different agents for cholesterol. I took all sorts of medications for aches and pains. I was headed right to diabetes,” said Cathy LaPlant of Shawnee, 59, who, at 5 foot 3, went from 297 pounds to 150 in the three years since her surgery at the University of Kansas Hospital.
LaPlant, whose private insurance paid for the surgery, is now off all major medications.
“It is a wonderful gift,” she said.
“It is a new chance to do it right this time around. … I can bound up steps.”Although teenagers are often equally effusive, speaking of what they experience as the near-miraculous and speedy way in which the surgery transforms their bodies and lives, weight loss physicians are saying hold on. Not so fast. Medicine and miracles, experience has proved, only rarely share the same stage. While more and more doctors see bariatric surgery as becoming a common and perhaps necessary tool in fighting a massive health problem, their optimism remains guarded. Before thousands of America’s obese children contemplate heading to the surgical suite, more needs to be known and caution exercised.
Later this year, the results of a five-year National Institutes of Health-sponsored study of some 300 adolescents ages 12 to 17, known as Teen-LABS (Teen–Longitudinal Assessment of Bariatric Surgery), are expected to confirm the kind of anecdotal benefits many already see.
“Striking improvement in quality of life,” said Marc Michalsky, an associate professor of surgery at Ohio State University and one of the study’s principal investigators at the Nationwide Children’s Hospital in Columbus, Ohio.
“These are kids, some of them taking blood pressure medications, or oral hyperglycemic medications, or they are on insulin for diabetes. Then these kids lose a significant amount of weight and those things go away.
“These are kids who tell you that, for the first time, they have a better attitude about life and their opportunities.”
Enthusiasm is tempered, however, because teens’ bodies are not adult bodies. They are still developing.
Some experts, concerned that the surgeries may interfere with the proper nutrition needed for growth of bones and reproductive organs, refuse to work on any patient until after puberty, when growth plates have closed.
A study published last year suggested that bariatric surgery may lead to weaker bones later in life because of mineral loss.
The surgery, moreover, is far from a quick fix. It requires a lifetime of new and healthy eating habits that most adolescents did not possess before. Otherwise, weight can be gained back, as it is in about 15 percent of adult cases.
Doctors question whether young patients, especially those steeped in college’s pizza and beer culture, can be disciplined enough to keep the weight off.
Plus, like all surgeries, it can have complications, including a small but very real post-surgical death rate of 0.05 percent (one in 2,000) for band surgeries in adults and about 0.1 percent for bypass surgeries in adults. Rates of serious complications, including blood clots and surgical perforations, range from 1 to 3 percent.
“It is controversial,” said physician John Price, medical director of the Center for Surgical Weight Loss at St. Luke’s Hospital.
“It just doesn’t play well if you operate on a 15-year-old and they die.”St Luke’s, the University of Kansas Hospital and North Kansas City Hospital all have surgical weight loss programs. None currently operates on teens, but Price said he operated on a few teens in Louisiana before coming to St. Luke’s.
Given the deteriorating health of obese kids, he envisions a growing number of teens for whom surgery may be the best option.
“What if a patient is 16 years old, weighs 350 pounds and has type 2 diabetes?” Price said. “There are these really large kids who are not going to get better. They need an operation.”
Kayleena Boyd was eager to have her surgery.
By age 15, the Mound City teen knew all too well what it would mean to remain obese. Like her, both her grandfather and mother had been large their entire lives. Terry Smethers, an athletic and strapping farm kid raised on farm food, weighed 221 pounds by age 13. But by age 66, the retired insurance salesman weighed 367 pounds, and his back, legs and organs were crippling him.
Kayleena’s mom, Lorie Boyd, weighed 82 pounds in second grade. Her sister was skinny. Her mom was skinny. They ate the same food, but on Lorie it went to fat, as it did in her dad. In grammar school, the teacher weighed her and everyone in front of the whole class.
“I still remember the humiliation,” Boyd said.And she remembers the isolation and the growing depression to the point, said Boyd, that as recently as 18 months ago, “I was on 19 different medications and I didn’t even want to get up. I didn’t care if I did anything.”
Neither she nor her father wanted that for Kayleena.
“You don’t want to see your kids miserable,” Smethers said. “And the granddaughter — she was in high school — started experiencing the same thing her mom went through.”It’s not that Kayleena was mercilessly teased. She wasn’t looked down upon, nor did she lack friends. Shy by nature, with ash blond hair and a wry smile, she was also athletic and involved in dancing, softball, 4-H and her church group.
Because of her weight and strength, she played middle school football and, from age 4 to 12, gained local renown as a national competitor in a rural event known as the “pedal tractor pull,” in which kids sit on tiny tractors and pedal them like tricycles to pull massive weights.
“With me being overweight, I knew I was as strong as the boys,” Kayleena said.
She once pulled 680 pounds and twice won championships.As puberty arrived, she also saw herself gradually being excluded from circles and activities.
“The girls I hung out with when I was skinnier, the bigger I got and the older I got, the less they hung out with me,” she said.
Kayleena and her family know what they should do: eat less, exercise, change their lifestyles.
But what people of normal weight don’t understand, Lorie Boyd said, is how extraordinarily difficult that becomes once someone gains an extra 100 to 200 pounds.
To be sure, numerous weight loss programs show it’s possible.
Children’s Mercy runs two programs, one for children ages 2 to 8, and another, PHIT (Promoting Health in Teens) Kids, for children ages 9 to 17. PHIT instructs overweight children and their parents on losing weight through nutrition, better cooking and exercise.
Kenya Williams, 35, of Gladstone, recently finished a 24-week program with her daughter, Miessa, a 14-year-old eighth-grader at Antioch Middle School. The two now eat more healthfully and work out regularly at the YMCA in the Northland.
“My self-esteem is better,” said Miessa, who so far has gone from 166 to 155 pounds. “I want to keep losing.”
Her mom has dropped from 260 to 202 pounds.“They teach you a number of things,” Williams said.
“Instead of two Pop-Tarts … you can have scrambled eggs, yogurt, a glass of milk — a lot of food that is less calories. They teach you types of exercise and how to get off the couch.”The Boyds tried dieting many times. It worked each time, but only temporarily. They would regain the weight they had lost plus more, which doctors say is common.
“Once a person becomes morbidly obese,” said Price, the St. Luke’s physician,
“they have only about a 10 percent chance of keeping that weight off.”The Boyds also tried to exercise more. But imagine, they said, attempting a single sit-up, push-up, pull-up or trotting a quarter mile with the full weight of another adult on your back.
“They tell you, ‘Go exercise.’ Well, it hurts,” Kayleena said. “They say, ‘It hurts because you’re overweight. Just push through it.’ They don’t understand.”
Both Medicare and many private insurers, depending on their plans, cover part or all of the cost of adult bariatric surgeries. Medicaid rules vary by state. Missouri Medicaid covers a portion of bariatric surgery in adults and, when medically necessary, adolescents. Kansas Medicaid covers neither. Private insurers often do not cover the surgery in children under age 18 because not enough long-term data exist to show that younger patients will make the diet and lifestyle changes needed to keep the weight off.
So Kayleena’s grandfather once again dug into his savings for another $12,000 to provide the surgery at the Bariatric Center of Kansas City, where he and his daughter had their operations.
Past puberty, Kayleena’s bone plates were closed. She was given a psychological workup to make sure she possessed the
“emotional and psychological readiness” for the obligations ahead.
“Understanding that you are never going to eat a whole pizza or drink a case of beer with your college roommates,” said the center’s surgeon, Stanley Hoehn.
“They need to understand this is a major life change.”There currently is no single set of agreed-upon medical criteria specifying when children are eligible for bariatric surgery. The one for adults is often used as a guide.
In general, children first need to have reached their adult height (around age 14 for girls, 15 for boys). They should have been repeatedly unsuccessful trying other weight loss management programs. They should have a BMI, or body mass index, of about 50 (about 290 pounds for someone 5 feet 4). Or they should have a BMI between 35 and 40 (205 to 230 pounds for someone 5 feet 4) along with evidence of a combination of other serious effects of obesity, such as type 2 diabetes, high blood pressure, fatty liver disease or sleep apnea.
Hoehn performed Kayleena’s surgery in October, and gladly so.
“It makes me happy to do weight loss surgery on young people,” he said. “We are changing the future they have, the jobs they might have, the person they will marry. She will not be diabetic. She will not get hypertension. She will not have knee replacement surgery at 45. It really derails that whole train.”
On an April weeknight, Kayleena was playing on her high school softball team, although injured with a bruised rib from a feat at the previous night’s practice that would have been unthinkable less than a year ago — diving and sliding head-first.
She is happy.
“The other day someone was like, ‘You look sexy today.’ ” she said.
“That was a first.”The big question, of course, is whether Kayleena and teens like her will keep their weight off.
Time will tell with adolescents, but the vast majority of bariatric surgery adults do. Price of St. Luke’s said that, in Louisiana, “anecdotally, my young patients almost universally did very well.”
“They are motivated to fit in socially,” he said.
“They do have very good weight loss and they tend to keep it off.”Marissa Nemechek, 21, of Overland Park, had bariatric surgery at age 17 at the Weight Loss Surgical Center, where her father is an executive.
“I’d been overweight since I was 8 years old,” she explained.
“I just ate when I was bored or lonely or whatever. I had somewhat of an addictive personality, especially with food, and it got to the point where by the time I was 17, I was 230 pounds.”She now weighs about 145 and said that, indeed, there are ways to regain weight after surgery.
Primarily it is by
“grazing,” continuously eating small amounts of high-fat or high-calorie foods, such as candy or alcohol or milk shakes that pass through the smaller stomach quickly without filling it up, and add weight.
But mostly, said Nemechek and others, the smaller stomach offers a kind of negative feedback and disincentive to overeating. It fills up fast.
“If you overeat, it can make you sick,” Nemechek said. “It’s not like vomiting. It’s like spitting up.”
Carbohydrates such as bread and pizza and rice tend to bloat the stomach uncomfortably, Kayleena said. She stays away from them and sticks to the recommended diet, which she said always begins with protein.
During a break in her softball game, she tossed the bread from a sandwich and ate the ham and cheese.
“Sometimes I eat half an egg and I’m full,” she said.Many bariatric surgery patients also take supplemental vitamins and minerals that they are no longer getting in their diet or are not being absorbed. Plus, they go to monthly support groups to stay on track.
If Kayleena has any cautions regarding the surgery, it would be not to have unrealistic expectations, she said.
Weight comes off, but it is not miraculous — about 10 to 15 pounds a month in the first several months and then about five pounds a month afterward.
“I want to lose about 20 more,” she said. “I lose sometimes a pound or two a week. It slows down.”
Which is OK by her.As it may be for her little brother, Kayson, 11, who is being teased and is already battling obesity, when he is old enough to have the surgery himself. His grandfather said he would pay. But if Kayson had his way, the surgery would come a lot sooner than age 15 or 16.
“Now,” Kayson said.Source: www.kansascity.com
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