Desperate Measures

[Guest guest]

Desperate Measures

As a last resort, more and more obese teens are having their

stomachs stapled. What are the risks?

By CHRISTINE GORMAN

A year ago, Ashlee Townsend, then 14, was running out of options. At

5 ft. 4 in., she weighed 330 lbs. and had developed Type 2 diabetes--

a potentially life-threatening illness that usually doesn't occur

before middle age. Ashlee had tried all sorts of diets, but none of

them seemed to work. By third grade, she had so much difficulty

walking that she started missing a lot of school. Then she underwent

an operation that reduced her stomach from the size of a football to

the size of an egg. In the 12 months since, she has lost 77 lbs.--in

addition to the 40 lbs. she lost while preparing for surgery--and

her diabetes is in remission. " The most amazing thing, " says

Ashlee, " is that I can see my feet when I walk. "

Townsend is testing one of the most controversial weapons in the war

against childhood obesity. Although the number is still small--

doctors estimate that perhaps 150 U.S. teens have undergone so-

called gastric-bypass surgery--it could jump dramatically. The

percentage of children who are overweight and obese has tripled,

from about 5% in 1980 to 15% in 2000, and a dozen hospitals around

the U.S. either have started doing gastric bypasses on kids or are

planning to. Dr. Inge of the Cincinnati Children's Hospital,

where Ashlee had the surgery, estimates that as many as 250,000

American teens may be candidates for the operation.

That has a lot of physicians concerned. It's one thing for

celebrities like TV weatherman Al Roker or singer Carnie to

undergo gastric bypass. We are used to adults, even those who aren't

famous, weighing the risks and benefits of such extreme treatments.

But high school students? Can kids who have trouble planning for

next week, let alone the rest of their lives, really understand what

they are getting into?

Gastric bypass works by radically altering the size and shape of the

stomach and shortening the length of the small intestine so that the

body can no longer take in normal amounts of food. First,

surgeons " staple " the stomach with surgical tools so that it can't

hold more than about an ounce of food. Eat more than five or six

bites, and you will feel a sense of nausea. Then the doctors

rearrange the small intestine, the organ that actually absorbs

nutrients, so that about a third of it can no longer function

normally. Patients must take supplements for the rest of their life

to avoid serious nutritional deficiencies. The procedure can, in

theory, be reversed, though doing so would require complex surgery

and the lost weight would probably be regained.

The bigger problem is that no one knows what this may do to someone

who is still growing. Even under the best circumstances, there are

substantial risks. As many as 1 in 100 obese adult patients dies

from the procedure. A woman died in Massachusetts last month after

the staples in her stomach apparently popped out. Blood clots and

serious infections are also possible. In addition, 15% of patients

regain the weight they lost. (By eating continually, you can stretch

even the tiniest stomach.) In short, says Dr. Ludwig, director

of the obesity program at Children's Hospital, Boston, " you're

substituting one potentially life-threatening condition for

another. "

On the other hand, it's hard not to sympathize with the plight of

these youngsters. Many have suffered with obesity their entire

life. " I just want to be able to go to a theme park and fit into any

ride I want, " says Paris Conley, 16, who is 5 ft. 7 in. and weighs

335 lbs.

" I would rather die on the operating table than go through life like

this, " Lebow remembers telling her mother. After surgery, the

5-ft. 3-in. Lebow shrank from 285 lbs. to 165 lbs.

Proponents of gastric bypass agree that it's not for everyone. " This

is a treatment of last resort, " says Inge. " The bar should be higher

for adolescents than it is for adults. " At Cincinnati Children's,

that means prospective candidates must be at least 130 lbs.

overweight--typical weights are 350 lbs. to 450 lbs.--or suffering

from Type 2 diabetes or severe breathing problems. The cost of the

operation runs from $25,000 to $40,000, and kids often miss a month

of school during recovery. Patients must also participate in the

hospital's nutrition, exercise and counseling programs. At Texas

Children's Hospital in Houston, which has decided to launch a

gastric-bypass program, patients must also agree to 10 years of

follow-up visits.

Why the rush? critics ask. Dr. Farmer, chief of pediatric

surgery at the University of California San Francisco Children's

Hospital, is among those who take a skeptical view. " Look, kids are

not dropping dead at age 19 from obesity, " she says. " Even in obese

patients who have diabetes or sleep apnea, there are treatments. "

There is still time, Farmer and others insist, to work on losing

weight the old-fashioned way through diet and exercise, which they

concede is hard but not impossible. Then if folks are still obese

when they reach adulthood, at least they are better prepared to

decide whether to undergo such radical surgery.

They will have more choices if they wait. One alternative that's

available to adults but not teenagers is the Lap-Band, a strip of

silicone that surgeons place around the stomach to constrict it.

Although the results have not been as consistently dramatic as with

gastric bypass, the Lap-Band procedure is safer, easily reversible

and less expensive (from $12,000 to $20,000). For the two years that

Lap-Band has been available in the U.S., its developers have

concentrated on the adult market. Now they are going to try to get

approval from the Food and Drug Administration to use it in

adolescent cases.

But there's a broader issue at stake. Even if gastric-bypass surgery

were as safe as getting your wisdom teeth pulled, you would still

have to ask yourself why so many American teenagers are obese enough

to consider it. Clearly we Americans, as a group, eat too much and

move too little. Sure, our parents, our genes and our self-control

play roles. But so do the presence of candy and soda machines in

schools, cutbacks in physical education and ever expanding portion

sizes in restaurants. If you tried to design an environment that

would promote obesity in the greatest number of people in the

shortest period, you could hardly do better than American pop

culture in the past 20 years.

Gastric-bypass surgery may work for some youngsters, but it is not

going to stop the epidemic of teenage obesity. Sooner or later, some

dramatic changes are going to have to be made in how and what we

eat. --Reported by Cole/Cincinnati, Dan Cray/San Francisco and

Deborah Fowler/Houston

With reporting by Cole/Cincinnati, Dan Cray/San Francisco and

Deborah Fowler/Houston