It’s the only thing that seems to work for some patients

American doctors are debating whether to offer bariatric surgery for severely obese young people. The market is huge: about 3 to 4 million teenagers are eligible, but only about 1000 a year have the operation. The proportion of adolescents who are severely obese has doubled nearly doubled between 1999 and 2014 – from  5.2% to 10.2 % of all people  aged 12 to 19.  But most doctors are deeply sceptical of the health benefits of the operation.

On the other hand, it is sometime the only thing that seems to work. “We’re at a point in this field where surgery is the only thing that works for these kids but we don’t know the long term outcomes,” Aaron Kelly, an expert in pediatric obesity at the University of Minnesota told the New York Times.

For many teens severe obesity is medically, socially and psychologically challenging. It is associated with type 2 diabetes, high blood pressure, sleep apnea, acid reflux, fatty liver and high cholesterol levels and depression. “I’ve had many patients tell me they’d rather be dead,” than remain fat, one doctor told the Times. .

On the other hand, it is not spectacularly successful. According to the most recent studies, most participants shed about one-third of their weight and kept it off for at least five years. But two-thirds remained severely obese and some developed vitamin deficiencies.

So doctors are thinking of offering the operation at an even younger age, since diets, exercise and behavioural therapy just do not work. The longer doctors wait, the more likely it is that the obese teenager will become an obese adult. “It obviously is a controversial area,” says Dr Marc P. Michalsky, of the Ohio State University College of Medicine.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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