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[O8]Obesity Gastric Bypass Surgery

by Donald Saunders, Don

Although the number of gastric bypass operations being carried out each year is growing as obesity rates continue to rise in many Western countries, weight loss surgery is still not considered by many to be a suitable solution for obesity in teenagers. This may however be changing and, while numbers still remain small, the number of teenage weight loss surgeries tripled between 2000 and 2003.

At present there are two issues as far as many surgeons are concerned when it comes to teenage obesity surgery. The first is whether or not the procedure is safe in adolescents and the second is how adolescent patients will fare in the longer term.

As far as the longer term effects of surgery are concerned this is a question that will only be answered in time and once a large enough group of adolescents have been through surgery and meaningful statistics are to hand. In 2003, for example, more than 105,000 bariatric operations were performed but, of these, less than 800 were performed on adolescents. Even though some consider that this is a meaningful sample size on which to draw conclusions about the longer term effects of surgery, we will nonetheless still have to wait several years before any conclusions can be drawn.

In terms of surgical success adolescents have proved to be excellent candidates for surgery, requiring less time in hospital, recovering faster than adults and experiencing fewer surgical and post-operative complications. This is perhaps not too surprising when you consider that most adolescents enter surgery without the other major medical problems which are often seen in adults. Most importantly the death rate from gastric bypass surgery in teenagers is very much lower than that seen in adults.

In addition to the two concerns related directly to surgery itself there is also the wider question of whether or not we should be following this route at all with teenagers. Weight loss surgery requires patients to make considerable changes to their lifestyle and there are psychological issues to be faced both before and particularly after surgery. It is one thing for adults to tackle these issues, but many people question whether this a burden we should be placing on adolescents.

At this point there seems to be little doubt that gastric bypass surgery is an effective solution to the problem of obesity in teenagers but time will be needed to assess the longer term effects of surgery and to allow for further studies to be carried out into the psychological aspects of surgery.

There are many different surgical procedures used nowadays from gastric bypass surgery which involves the reduction of the size of the stomach and the bypassing of a section of the intestine to limit the quantity of food eaten and the ability to absorb calories from that food to lap banding which merely decreases the size of the stomach to once again limit the quantity of food which can be consumed.

Whichever form of surgery is performed the basic principle is to make the body burn off a greater number of calories than can be absorbed and so reduce weight by using up the body's reserves of fat.

The real problem with gastric bypass surgery however is not to be found in the actual surgery itself but is seen in the months after the operation when individuals find that their lifestyle has to change radically and that they have to adjust to a whole new eating system. For many people this is difficult but for some it can bring serious difficulties which are simply too much for them to cope with.

There are a lot of reasons for obesity but a couple of common problems demonstrate this point.

The first is the problem of those individuals whose obesity has been caused, or aggravated, by emotional eating. Here individuals turn to eating whenever they are stressed or when their emotions are particularly low. Emotional or comfort eating can develop into a very strong habit which is difficult to break and the psychological pressures which normally follow gastric bypass surgery are precisely the kind of pressures which will trigger the desire for comfort eating in individuals who suffer from this difficulty.

The second is the problem of those individuals who are prone to binge-eating and the uncontrollable disgust, depression and guilt which normally follow binge-eating bouts. It is very easy to see the extreme difficulty which such individuals will experience in trying to deal with the significant lifestyle changes after gastric bypass surgery.

When these and other factors are taken into account it is possibly not surprising to learn that in the region of 20% of people being considered for bariatric surgery are not suitable, or perhaps more correctly not ready, for surgery which is where psychological obesity treatments come into play.

A lot of attention is given to the requirement for individuals to meet specific physical requirements for surgery (in terms of things like their body mass index and the existence of other medical problems associated with their being significantly overweight) but far too frequently little attention is given to very real psychological problems which are associated with surgery. For surgery to be given the very best possible chance for success then it is critically important to look carefully at the psychological requirements of individuals and to provide them with pre-operative assessment, counseling and, most significantly, treatment.

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