Adolescent Bariatric Clinic Helps Obese Teens at High-Risk for Medical Problems

St. Louis Children’s Hospital (SLCH) has teamed with the Washington University Surgical Weight Loss Program and Barnes-Jewish Hospital to establish the first adolescent bariatric clinic in the St. Louis area. The clinic focuses on teens whose weight is causing them to have significant medical problems that likely will result in serious complications as they mature into adulthood.

“We are seeing an increased incidence of really severe complications from obesity in adolescents, including high blood pressure, type 2 diabetes, metabolic syndrome and Blount’s disease,” says Abby Hollander, MD, interim division director of endocrinology and diabetes at SLCH. “While diet and exercise remain the gold standard for weight loss, teens who are severely obese often have extreme difficulty reducing their BMIs into a normal range. Although it’s not known why this is true—both hereditary and environmental factors probably play a role—the fact remains that many of these teens benefit greatly from undergoing bariatric surgery.”

Criteria for teens seen at the adolescent bariatric clinic include:

• Being 15 – 19 years of age with a BMI of 40 or greater
• having been diagnosed with a serious medical condition
• having reached the maturity level needed to undergo major surgery and commit to a new lifestyle.

All patients undergo an evaluation by an SLCH pediatric endocrinologist; Esteban Varela, MD, FACS, Washington University bariatric surgeon and clinic co-director; a psychologist and a registered dietitian. Families also are evaluated to gauge their commitment to providing emotional support and helping to change the teen’s living environment.

In addition, before undergoing surgery all patients must first complete a six-month weight management program during which they either lose or maintain their weight. This requirement shows patients’ commitment to adhering to healthy eating, and it helps them learn the lifestyle and diet changes they’ll need to make following surgery. Those changes include eating only three small meals a day, eating only healthy foods, not snacking, giving up soda and exercising at least 30 minutes a day.

Dr. Varela notes that bariatric surgery is becoming more common in obese teens, and new research suggests it may be more effective than behavioral programs alone. Dr. Varela was the lead author in a study that showed bariatric surgery in adolescents has proven to be as safe as in the adult population.¹

“Performing bariatric surgery when patients are adolescents means we can have a significant impact on their lives early on,” says Dr. Varela. “Their overall health and quality of life is drastically improved, and that means avoiding the irreversible health issues that adults deal with even after they’ve undergone bariatric surgery.”

Dr. Varela performs three types of bariatric surgeries:

• Adjustable gastric band, which decreases food intake by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. The outlet size is controlled by a circular balloon inside the band that may be inflated or deflated with saline solution to meet the needs of the patient.
• Roux-enY gastric bypass, which restricts food intake and decreases food absorption. Food intake is limited by a small pouch similar in size to the adjustable gastric band. In addition, food absorption in the digestive tract is reduced by excluding most of the stomach, duodenum and upper intestine from contact with food by routing food directly from the pouch into the small intestine.
• Vertical sleeve gastrectomy, which restricts food intake but does not lead to decreased food absorption. Approximately 60 percent of the stomach is removed, reshaping it into a tube or “sleeve.”

“All of these surgeries are done laparoscopically, which means patients’ hospital stays are only a day or two,” he says. “They are followed closely for the first year and then have annual check-ups.”

He adds, “Of course, surgery is always the last resort for adolescents who are obese. But when they are at high risk for developing severe health problems as adults and they have been unable to reduce their weight any other way, this intervention is the best course for them.”

For more information about the adolescent bariatric clinic, call Children’s Direct at 800.678.HELP (4357).

^{1 Varela JE, Hinojosa MW, Nguyen NT. Perioperative outcomes of bariatric surgery in adolescents compared with adults at academic medical centers. Surgery for Obesity and Related Diseases, September 2007;3(5):537-40.}