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09.30.10

The Teen Weight-Loss Surgery Boom

A new study suggests that more adolescent girls are getting drastic weight-loss surgery so they can look skinnier. Alizah Salario on the procedure that has some doctors nervous.

As a teenager, Allison Schroeder tried everything to lose weight. She exercised. She consulted doctors and went on diets. Nothing worked. She shed some pounds during a backpacking trip while maintaining a vegetarian diet, only to regain the weight when a back injury left her less active. By her 18th birthday, Schroeder weighed 268 pounds and suffered from high blood pressure and cholesterol.

“I didn’t feel my life was worth living," she said, "so I needed to make a change."

Schroeder’s mother, a bariatric nurse who’d had gastric bypass surgery herself, brought up the possibility of weight-loss surgery to her daughter. Schroeder wasn’t the only teen weighing the option.  The journal Pediatrics recently reported that gastric banding, an increasingly popular type of weight-loss surgery not yet approved by the FDA for adolescents, skyrocketed nearly seven-fold from 2005 to 2007 among California teens, with white girls disproportionately opting for the procedure. Because the gastric band is not FDA-approved in teens 14-to-17, the only way young teens can get the procedure is through a clinical trial—a form of medical research held under the supervision of a hospital. Clinical trials are often sponsored by the government or pharmaceutical companies, and use small groups of patients to gather enough data to show whether or not a procedure is safe and effective enough for FDA approval. Females accounted for nearly 80 percent of the 590 teens who underwent surgery in the study, even though they make up less than half of overweight adolescents, researchers at UCLA reported.

Shortly after her birthday, Schroeder decided to get an adjustable gastric band known as the Lap-Band. Gastric banding is a procedure that cinches a silicone band around the top portion of the stomach, restricting food intake and causing patients to feel full quicker. Because gastric bands like the Lap-Band are reversible, and the procedure is less-invasive and requires a shorter recovery time than other weight-loss surgeries, it has become increasingly popular since its FDA approval for adults in 2001. (Before, gastric banding, a non-reversible procedure that requires a deep incision into the abdomen known as gastric bypass, was the primary weight-loss surgery option.)

Today, five years later and nearly 100 pounds lighter, Schroeder has found the procedure far more complicated than it’s made out to be. It drastically limited what she could eat at first, and though Schroeder’s main health-related issue was heartburn, many of her peers in her support group had serious complications and struggled with dietary restrictions. That’s why she objects to the way weight-loss surgery is promoted.

“I think it’s horrible that there are these advertisements,” she said. “I hate it. I don’t think it’s something that should be thought of lightly. It’s not, ‘Oh, I can look prettier.’”

Weight-loss surgeons and gastric-band manufacturers use both traditional and social media to target consumers. Billboards dotting freeways across the country are plastered with weight-loss surgery ads and the number 800-GET-SLIM—notably, not 800-HEALTHY. Both Allergan and Johnson & Johnson, manufacturers of the Lap-Band and the REALIZE gastric bands, respectively, have YouTube channels that showcase glowing patient testimonials. In some videos, women preparing for a photo shoot flaunt newly slim figures like their best accessories.

“I don’t think it’s something that should be thought of lightly. It’s not, ‘Oh, I can look prettier,’” says one young woman who got the surgery.

Though gastric banding has been touted as a safer and less-invasive alternative to gastric bypass, studies show conflicting data. The American Society for Metabolic and Bariatric Surgery states that the overall likelihood of complications from bariatric surgery is just 4 percent, and the Pediatrics study cited a 5 percent band revision or removal rate for the gastric band. Yet long-term data shows strikingly different results. Swiss researchers who published a study in Obesity Surgery found that over a 10-year period, the complication rate for adults was an astonishing 74 percent, including surgical revisions, band erosion, and food intolerance—with a failure rate approaching 40 percent.

The Pediatrics study also noted that the rise in adolescent gastric banding corresponds with a “significant increase” in gastric-band marketing to adults. The FDA recommends adjustable gastric banding for severely obese adults with a Body Mass Index of 40 or a BMI of 35 if obesity-related complications are present, but anyone who wants the surgery can elect to have it done after undergoing psychological screening if they fit these parameters. Last year, approximately 22,000 American adults got gastric banding.

The increasing number of young girls getting a surgery with a complication rate of up to 74 percent has raised concerns—especially since the increase is occurring even while adolescent gastric banding is still considered “off-label” and can’t be marketed or promoted directly. If the procedure gets the green light from the FDA, what will happen when an industry that already capitalizes on overweight adults’ vulnerabilities is allowed to target teens?

“As much as we want to be neutral and not get caught up with the body-image piece, because this is a medical procedure, you’re seeing that culturally there is a lot of pressure to look a certain way,” said Melainie Rogers, a registered dietitian and founder of the BALANCE eating-disorders treatment center in Manhattan, who has worked extensively with bariatric surgery patients.

Advocates of the surgery say it can prevent obesity-related diseases like diabetes. Yet for teenage girls, a group particularly vulnerable to peer pressure and the effects of advertisements, it’s difficult to know whether motivation for surgery comes from a desire to be healthy or a desperate need to be thin. When does a medical procedure become a cosmetic shortcut?

“Some of the emotional reasons are cosmetic because our society is so hard on teenage girls to be thin,” admitted Schroeder. “I have to say, I do feel a lot more accepted as a thin person.”

“The picture is of a woman’s midsection,” said Rachael Stern, referring to the surgery's advertisements. Stern got the Lap-Band five years ago at age 20 and subsequently developed anorexia. “That ad is not geared toward someone who wants to cure diabetes. It’s geared toward someone who wants to look hot in a bikini.” After getting the surgery, Stern said she felt like she traded one problem for another. Because her food intake was restricted after surgery and she was supposed to be losing weight anyway, doctors failed to recognize the warning signs as she slipped into disordered eating.

“I do worry about projecting this as an easy solution for dealing with a difficult problem for teens,” said Dr. Edward Livingston, chairman of Gastrointestinal Surgery at the University of Texas Southwestern Medical Center in Dallas. “I’ve rarely seen a kid who has the emotional maturity to handle one of these operations,” he continued, noting the drastic post-op lifestyle and eating modifications. 

“We really do try to look at the motivation,” said Dr. Michael Devlin, professor of clinical psychiatry at Columbia University who works with adolescents in the university’s laparoscopic banding program. He is one of the health professionals responsible for prescreening adolescents and determining if they possess the emotionally maturity to handle the results. Devlin emphasized that it’s rare for patients to lose all of their excess weight after surgery, and teens with unrealistic expectations about transforming their bodies to fit a narrow ideal of beauty are more likely to have difficultly in the long run. “A big part of it has to do with accepting a larger than normal body size,” he said.

For clinical psychologist Phyllis Zilkha, the potential complications of surgery are not just physical. “It teaches the wrong thing, that we don’t have control over our bodies and we have to give them over to someone else to fix,” she said.

What happens when the promised thinness and beauty doesn’t last?  Unfortunately, explained Livingston, it often won’t.

“Now that it’s been widely acceptable for 10 years, we’re seeing people who’ve regained all their weight. What worries me about doing baratric surgery on kids is that they’ll regain their weight early in their lifetime,” said Livingston. “If you do surgery on a kid who is 15, you don’t really know what’s going to happen 40 years down the road. There could be a whole class of problems that we don’t even think about.”

So far, Schroeder doesn’t have regrets, and she knows that “you can’t stop companies from advertising.” Still, seeing weight-loss surgery promoted as a “miracle” makes her angry.

“Obviously, we should be teaching kids to love their bodies no matter how they are.”

Alizah is a former high school English teacher and a journalism fellow at the Poetry Foundation in Chicago. She is a graduate of the Columbia University Graduate School of Journalism.