Extreme Measures

It may seem hard to believe that Stuart Logan was once a normal-size kid. At six foot two and 585 pounds, he no longer hangs out at the local '50s-style diner with stools and servers in pin-striped uniforms, because he can't fit into the seats. He sits in the handicapped section at the movies, where the chairs have no arms, and only uses toilets bolted to the ground (those attached to the wall may not support his weight). He doesn't wear seatbelts because they aren't long enough to stretch across his chest. He buys two seats in coach when he flies.

Life was not always like this for Stuart. His mother, Margaret, says he first started putting on the pounds at the end of first grade--but he didn't stop. By sixth grade, he was nearly five foot eight inches and weighed more than 300 pounds. "If there is a fat gene, he got it," says his mother, who has struggled with her own weight, too (as has his father, Buddy).

Now 16, Stuart weighs more than both his parents combined, despite various attempts at diets, from Atkins to Weight Watchers. Stuart even worked with a personal trainer for a few months. But he always regained the weight he lost.

These days, hitting the gym is out of the question. It can be a struggle just to walk up and down the stairs of his family's two-story house in Redmond, Wash. Stuart, who has taken a year's leave of absence from his high school, spends most of his days at the computer, e-mailing friends, playing games or writing. "It's hard to exercise at his weight," says his mom.

So about a year ago, his parents suggested surgery. Later this month, Stuart will undergo gastric-band surgery, a relatively new procedure that involves wrapping a silicone band around the upper part of the stomach to create a pouch, narrowing the passage to the rest of the digestive system. Like the more commonly performed gastric bypass surgery--in which surgeons create a small stomach pouch and then attach a section of the small intestine to the pouch to allow food to bypass the lower stomach--the aim is to make patients feel fuller faster. But unlike bypass surgery, gastric banding does not permanently alter the stomach; it can also be adjusted nonsurgically by injecting saline solution into the band.

The procedure is the most common form of weight-loss surgery outside the United States, particularly in Europe and Australia where it's been performed for more than a decade. But Inamed Corp.'s Lap-Band is the only gastric banding device that the Food and Drug Administration has approved so far for use in the U.S.--and the agency only did so in mid-2001. And surgeons must complete an FDA-required training and proctoring program before they can perform the procedure. So far, about 600 surgeons in the U.S. are certified, and they've performed more than 35,000 of the Lap-Band procedures. Gastric bypass, which has been performed in variations for more than 30 years in this country, remains the more popular procedure. Of the estimated 140,000 weight-loss surgeries performed in 2004, according to the American Society for Bariatric Surgery (ASBS), only about 11 percent were Lap-Band procedures. Now, the Lap-Band is gaining popularity. Thomas Abraham, a product marketing manager for Inamed, says Lap-Band's annual sales in the U.S. quadrupled between 2001 and 2004. And Ethicon Endo-Surgery, a division of Johnson & Johnson, has its own band in clinical development now.

The procedure appeals to younger patients, like Stuart, who are wary of permanently shrinking their stomachs. "For the next few years, I think there will be a growing number of teens having the surgery done," says Dr. Christine Whyte, a pediatric surgeon at the Children's Hospital at Montefiore in New York City, which performs both gastric-band and gastric-bypass procedures.

While insurance companies have started to cover at least part of the costs of both weight-loss surgeries--$15,000 to $25,000--in adults, they are more hesitant about teens. The Logans are paying out of pocket for Stuart's surgery. "Monetarily it's a big investment," says his mother, who owns a small business distributing auto and security products with her husband. "But he's worth it."

There are no official statistics on teens and adolescents who've undergone either weight-loss surgery--estimates range in the hundreds--but there's little doubt the number is growing. Stuart's surgeons, Dr. Kevin Montgomery and Dr. Brad Watkins, say they know of two other teenage candidates considering the procedure. And surgeons at NYU Medical Center, one of the leading Lap-Band centers, have performed at least 2,600 of the surgeries, some on patients as young as 12. The FDA has only approved Lap-Bands for adults, but they are available off-label for younger patients. That means surgeons may opt to use the device in some teenagers and adolescents, based on the patient's condition and their own clinical experience.

Meanwhile, the pool of potential candidates is growing. The rate of seriously overweight kids has quadrupled in the past three decades; about one in six kids today is obese. For many of them, diets and exercise don't seem to be enough to get rid of the excess weight. "We're really talking about severely obese teens for whom nothing else has worked," says Harvey J. Sugerman, ASBS president.

Candidates--especially young ones--are carefully screened before either procedure. In order to qualify for any weight-loss surgery, patients must be considered morbidly obese, meaning they're at least 100 pounds over their ideal weight or have a Body Mass Index (BMI) of 40 or more (calculate yours here). In some cases, doctors will perform the surgery on those with a BMI as low as 35, if the patient has weight-related health problems such as diabetes, high blood pressure or heart disease. At Stuart's weight, "waiting didn't seem like a good idea," says Montgomery. He and Watkins have performed more than 500 of the Lap-Band procedures since they founded Northwest Weight Loss Surgery in Seattle in the fall of 2002, but Stuart will be their first teenage patient.

Stuart says he opted for the gastric-band procedure, which his parents told him about after attending a seminar on weight-loss surgery, because it seems less risky and less permanent. "I am a little concerned about having a band inside of me," he says. "But at least it is reversible and adjustable."

Gastric bypass patients also have more difficulty absorbing vitamins and minerals after the surgery, so many take daily supplements for the rest of their lives--a regimen Stuart's mother didn't want to push on her son. According to the National Institutes of Health, bypass operations produce more weight loss than restrictive operations like gastric banding and are more effective in reversing weight-related health problems, too. Patients who have bypass operations generally lose two thirds of their excess weight within two years, according to the agency. But three or four years after surgery, Inamed says the average weight loss for Lap-Band patients is comparable to those who have bypass surgery. And some studies have shown Lap-Band procedures to be less risky. Dan Cohen, Inamed's vice president of global corporate and government affairs, says the mortality rate for Lap-Band procedures is now less than five-hundredths of a percent--comparable to the risk of dying from a hernia operation. ASBS estimates one in every 200 patients dies from gastric-bypass surgery. Though that includes patients who suffered from other health problems before the operation, "when you are counseling people about this kind of surgery, it is hard to hear that number," says Whyte, the pediatric surgeon. "Gastric bypass is a bigger surgery with potentially more hazardous complications, and the patient has to live with that surgery for a long time."

Surgeons stress that while both procedures can help accelerate weight loss, neither is a quick-fix solution. "Obesity surgery is a tool to help people change their lifestyles," says Whyte. "All by itself, it probably won't be successful in the long term. You still have to eat less and exercise more."

So before Stuart can undergo the Lap-Band surgery, his surgeons are requiring him to enroll in a nutrition program and to commit to making long-term diet and lifestyle changes. The teenager has pledged to lose 30 pounds before the operation. For the Logan household, that's meant replacing regular soda with diet brands and candy bars with carrots and removing all the chips but tortilla (the only kind Stuart dislikes, according to his mother). Stuart has started ordering salads when they go out for dinner ("Now if I can just get him to switch from fried chicken on top to grilled," she says). "And I'm trying to take the stairs more," adds Stuart.

So far, he is about halfway there. "And I already feel a lot better," says Stuart. Once he undergoes the surgery, he could lose 10 times that weight. That's still hard for Stuart to imagine. But he saw evidence of the dramatic weight loss when he attended a mandatory support group in December for patients with Lap-Bands and those considering the surgery. He also learned that while he is the youngest of Montgomery's patients, he wasn't the biggest. Michael Short was 593 pounds when he underwent the Lap-Band procedure in July 2003. The 43-year-old Seattle man has since lost 180 pounds. Though he is still overweight, Short says, "My wife is no longer afraid I'm going to die."

Short is off his diabetes medication, and his legs are no longer swollen--though a scar on his ankle remains where the build-up of fluid became so bad that he had to have a skin graft. Short was so excited about the weight loss that he bought a motorcycle to celebrate (he couldn't fit on one before the surgery); he was even more excited when he was able to walk the three miles home without stopping after the bike broke down last spring. "This has been a life-changing experience," he says.

For Stuart, he's hesitant to hope for too much from the surgery. "I'm trying not to go in with expectations that are too high and be disappointed," he says. "I'd be happy if I just wasn't constantly hungry."