Weight, Weight, Don't Tell Me

By Helen Cordes, AlterNet. Posted January 19, 2005.

At age 15, Charlie Fabrikant opted for the knife. Gastric bypass surgery was about the only thing the suburban Chicago teen hadn't yet tried, to lose some of the 350 pounds that were literally making him sick.

"Joint pain was a killer," says Fabrikant, who loves sports but found that "every time I'd try to play, I'd really hurt." Severe heartburn plagued his days, and at night, "I'd wake up gasping for breath because of sleep apnea."

The unrelenting physical effects of the weight pressing down on his bones, stomach, and lungs was compounded by the mounting depression of always being the fat "outsider," an ache that had him returning to food for comfort. "I've been on diets since third grade," Fabrikant says, including hospital supervised diets, Weight Watchers, and diet drugs such as Meridia, the antidepressant Wellbutrin, and the epilepsy drug Topimax. "I'd lose a few pounds each time, but then I'd gain back more."

Last December's surgery, which stapled off all but an egg-sized part of his stomach that was reconnected to his small intestine, "changed my life," says Fabrikant. "I've lost 130 pounds and I've only got 40 more to go to my target weight!"

He's ecstatic that he feels satisfied after eating one of the six half-cup portions that make up his daily meals. "Before, I'd have two Big Macs and still be hungry," he recalls. He's playing sports again, and rides an exercise bike six miles a day. "My bone pain, the heartburn, and the apnea have all disappeared," he says proudly.

Rise In Surgery

Obese teens are a thriving slice of the dramatic rise in gastric bypass surgeries that soared from 16,200 in 1992 to an estimated 140,000 in 2004. Over 1,000 teens had surgeries last year, estimates Dr. Thomas Inge, director of the Comprehensive Weight Management Center at Cincinnati Children's Hospital.

The idea of a kid as young as 13 undergoing permanent stomach surgery sounds shocking to many. But surgery advocates such as Dr. Richard Atkinson, president of the American Obesity Association, defend the choice as a necessity: "Statistically speaking, obesity prevention and dieting simply hasn't worked."

American children lead the world's ranks in obesity, with 15 percent obese and another 30 percent overweight. Some 250,000 teens are at least 100 pounds overweight, a guideline often used for adult surgery criteria.

Kids as young as elementary school are developing the first stages of diabetes, heart disease, osteoarthritis, liver dysfunction and other illnesses that are typically paired with obesity. "We don't think of surgery as a weight-loss option," says Dr. Joey Skelton, director of the weight management program at the Children's Hospital of Wisconsin. "It's a last-ditch effort to address illness."

The teen surgery rise "is very appropriate," says Atkinson. "For the morbidly obese, nothing is anywhere near as effective." And when the weight stays off, patients who had diabetes or hypertension can sometimes reduce or eliminate medications.

But if many more teens head for the operating table, critics fear that they'll be subject to the same disturbing trends affecting the thousands of adults who have had surgery. The rate of complications and death from the procedure has edged up, as inexperienced surgeons flock to an industry valued at an annual $3 billion. Many patients regain some or all of their weight, and need re-operations.

And the long-term effects on kids "are a huge unknown," says Dr. Paul Ernsberger, associate professor of nutrition at Case Western Reserve University. Ernsberger and other critics worry about the eventual effects on brain, bone and muscle growth and health when a major source of nutrient absorption is bypassed during the teen years. "What will kids be experiencing 20 or 40 or 60 years from now?" Ernsberger wonders.

The Obesity Tradeoff

For now, weight-loss surgery is a hot property, pushed by several potent factors. Marketing is at a fever pitch. Consumer demand is very high, with many hospitals booked months in advance with adults and teens, and insurers inundated by coverage requests. The ranks of the American Society of Bariatric Surgeons have swelled from 168 in 1993 to 860 in 2003, and critics complain that many hang out their shingle after a single weekend training.

While successful surgery scenarios – well trained, experienced surgeons with lots of hospital backup – have low complication and death rates, other situations can produce tragic results. Houston attorney Richard Mitloff represents 28 surgery patients who got their surgeries at facilities owned by a major Texas hospital chain.

"They marketed the surgery very aggressively," Mitloff charges. "They'd pay the airfare for patients, bring them in by limo, with an elaborate last meal before the surgery." After the surgeries, four patients died, and the others experienced major infections, stomach leakages, and other complications requiring more surgeries and leaving permanent injuries.

"Surgery can be very beneficial in the right circumstances," says Mitloff. "But this is a very lucrative business with procedures getting $30,000 to $40,000 each. A number of hospitals see nothing but dollar signs."

Helen Cordes is a freelance journalist based in Texas. She is writing about childhood obesity as a 2004 Journalism Fellow in Child and Family Policy through the University of Maryland.

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