Should supersized teenagers undergo such drastic measures to lose weight? Some doctors who have seen a handful of such patients say yes
SINGAPORE — Like many obese individuals who resort to weight loss surgery, Mr Nikhil Gangaram had tried dieting and exercise, but failed to keep his weight down. Unlike most of them, however, he is only 19.
The experience undergoing bariatric surgery late last year to remove part of his stomach was the “most painful thing” he has ever put himself through. But since then, the full-time National Serviceman – who is 1.83m tall and used to weigh 119kg – has reduced his food intake significantly and shed 16kg. It is a result he considers a “miracle”.
The benefits of bariatric surgery are well-established, but should supersized teenagers undergo the drastic procedure traditionally recommended for adults?
Bariatric surgery is not commonly carried out on children and teenagers, but some doctors here have operated on a handful of young patients. As childhood obesity rates go up, they feel it can help severely obese youths to achieve normal weight and tackle related health issues more effectively.
Bariatric surgery has been proven to produce long-lasting weight loss results and improve obesity-related conditions such as Type 2 diabetes, sleep apnoea and high blood pressure, said Dr Ganesh Ramalingam of G & L Surgical at Mount Elizabeth Novena Hospital, who operated on Nikhil.
Patients generally lose 50 to 60 per cent of their excess weight within a year of surgery, said Dr Ganesh, who added that Nikhil is among his youngest patients to have undergone weight loss surgery.
About 25 to 40 per cent of children who are overweight will have metabolic syndrome, a cluster of conditions that includes abnormal lipid levels, high blood pressure and insulin resistance, which sets the stage for diabetes and heart problems, he said. But when obese youths lose weight, the negative effects of metabolic syndrome may be reversed.
Dr Melvin Look, director of PanAsia Surgery and a consultant surgeon in gastrointestinal, laparoscopic and obesity surgery, has seen a handful of patients under 21, the youngest of whom was 16.
Researchers believe some individuals may have the genetic tendency for easy weight gain. Coupled with factors such as a sedentary lifestyle or exposure to high-calorie food, obesity may then result.
Doctors start off with a weight loss plan that involves diet and exercise for at least six months. But in 90 per cent of obese teenagers, this approach does not work, said Dr Look.
“That is why surgery is sometimes necessary to ‘reset’ the bar and correct some of the metabolic effects of excessive weight gain,” said Dr Look.
The surgery will work well for severely obese teenagers who are emotionally well-adjusted and are motivated enough to understand and comply with the treatment plan, he said. They must also have reached a certain percentage of their height potential to avoid any post-surgery nutritional deficiencies that may stunt their growth.
High-risk adolescents with morbid or extreme obesity (a Body Mass Index (BMI) of over 40) and weight-related complications can be considered for bariatric surgery, as there is increasing evidence to show certain cases will benefit from it, said Associate Professor Oh Jean Yin, deputy head of the department of paediatrics and senior consultant at the adolescent medicine service of KK Women’s and Children’s Hospital. The hospital has not performed bariatric surgery on children or adolescents so far.
The decision must not be taken lightly.
“The clinical decision for bariatric surgery to occur must be strictly based on criteria and indications after undertaking a comprehensive assessment and consideration of any medical, surgical and psychosocial risks,” said Assoc Prof Oh.
GUIDELINES IN PLACE FOR THOSE BELOW 18
To qualify for bariatric surgery, paediatric patients under 18 must fulfil a list of criteria, such as having a BMI above 40 and with other significant severe medical problems like diabetes, or a BMI of at least 50 without related medical conditions, according to the Ministry of Health’s Clinical Practice Guidelines (2016).
The surgery must also be part of an adolescent bariatric specialty programme, which involves a dedicated multi-professional team. Every patient will require extensive assessment, including mandated participation in a medical weight management programme for at least six months, said Assoc Prof Oh.
In addition, there must be protocols to ensure good outcomes in weight loss after surgery while minimising complications and problems such as nutritional deficiencies, growth and puberty, adherence issues, weight gain and disordered eating behaviour, said Assoc Prof Oh.
Parents considering bariatric surgery for their teenage children should bear in mind that lifestyle and diet changes must be made as a family for the weight loss journey to be successful, said Dr Ganesh.
Patients must be fully committed in preparing themselves for the surgery.
“Preparing for this major operation can take many months of work. Patients need to show that they are willing and able to make big changes in their eating and exercise habits before the surgery,” said Dr Ganesh.
Nikhil said his parents used to spend “thousands of dollars” on his diabetes medications every month.
He had Type 2 diabetes, high blood pressure and high cholesterol, and had spent most of his teenage years on multiple medications to control the diabetes and other obesity-related issues.
When he was about 13, his blood sugar level hit 63 millimoles per litre, about eight times the upper limit of what is considered normal.
Then, there were the social and emotional issues as well as the inferiority complex he had as an obese child.
“I was teased in school for being fat… and this continued till I was in secondary school. I was always the last to be picked for sports as I was unfit and would hinder the team. Physically, I did not feel good and, psychologically, I felt even lesser than other kids as I was not confident of myself,” he said.
While the recovery period was “frustrating” due to pain and the inability to eat normally – he was put on a special clear liquid diet for the first three weeks – Nikhil said undergoing the sleeve gastrectomy procedure was “the best decision” he has made in his life.
He no longer needs to visit his endocrinologist as frequently, and does not require medications at the moment as his bloodwork is normal.
“I am no longer my previous sluggish self, and this has motivated me to lead a healthier and more fulfilling life,” said Nikhil.