Weight-Loss Surgery for Teens Who Can’t Lose Weight Any Other Way

Certainly this was no quick fix. She went through a yearlong process of trying supervised weight loss, driving an hour and 15 minutes every month to meet with a physician, a dietitian and a mental health specialist. “I would have to take that entire day off school, my mom off work,” she said. “We had to do this once a month for a year before we could be referred to a bariatric center.”

After she had the surgery, at 16, her hypertension and prediabetes got better. She was honest with her college roommates, not wanting them to see the small meals she needed after surgery and think she had an eating disorder. She had to navigate other problematic college food situations, she said, with cookie deliveries and late-night pizza expeditions. But from a weight of around 270 pounds (she is 5 foot 8), she has now stabilized around 190. “I’m still technically from a B.M.I. category considered overweigh t,” she said. “I’m comfortable and I’m happy with my body.” She is serious about fitness and works out four or five times a week.

Perhaps the most sensitive question the policy statement examines is: How young is too young? Most of the studies involve older adolescents, though some international research looked at 12- or even 10-year-old patients. There is no lower age limit in the policy statement because the researchers could not find evidence drawing a firm line to mark a lower age boundary; the decision should rest with a whole team, including the child and the family, the pediatrician and the surgeon.

There are major disparities in access to bariatric surgery. “Childhood obesity disproportionately affects children of color and those in low-income populations,” Dr. Armstrong said. “Those getting access to surgery are almost exclusively middle- and upper-class white adolesc ents.” The biggest barrier is lack of insurance coverage; many private payers will not cover the surgery for those under 18, and almost no public payers will.

Often, childhood obesity is seen as the parents’ fault, and some worry that bariatric surgery is being offered as a quick fix. Dr. Armstrong noted that in many cases, the parents themselves “have struggled with their weight most of their lives and want nothing more than to have their kids not go through this.” She added, “Most of them have tried everything they were capable of doing” to help their children lose weight.

The impulse to keep trying with diet, nutrition and behavioral modifications runs deep in pediatrics, but the evidence suggests that if an adolescent needs bariatric surgery, it’s better not to wait too long, Dr. Armstrong said. “Watchful waiting for extended periods of time can actually lead to less effec tive surgery and surgery with more complications.”

Weight loss surgery generally reduces B.M.I. by about 10, so if the patient is a 16-year-old with a B.M.I. of 45 (anything over 35 generally meets the criteria for severe obesity), the B.M.I. going into adulthood after surgery is likely to be around 35 â€" still obese, but much less severe. On the other hand, if the same child waits until the age of 19, when the B.M.I. may have gone up to 55 â€" you can do the math.