Bariatrics surgeon Dr. Nicole Lee is taking baby steps in the treatment of younger patients who are morbidly obese.
Kids today. They’re getting bigger and bigger. And not in a good way.
A whopping 18.5 percent of children and adolescents in the United States are obese, defined as a person with a body mass index of 30 or more.
And the rate of U.S. teens between ages 15 and 19 heavy enough for bariatric surgery increased to 9.9 percent in 2016 from 6.6 percent in 1999, according to research published in the journal Pediatrics.
But is life-changing surgery a good idea for adolescents? Even if it means lowering their risk of obesity-related illnesses?
That depends on their mental state, level of maturity and family support, says IU Health surgeon Nicole Lee. Though once considered too extreme for growing teens, within the past decade, the surgery has become more acceptable.
Morbid obesity is defined as a BMI score of 40 or more. A person might qualify for bariatric surgery if he or she has a BMI of 35-39 and is at least 100 pounds overweight, with significant health problems like type 2 diabetes, sleep apnea or high blood pressure.
Dr. Lee is taking baby steps to help treat young people who are dangerously overweight. Not young teens, but those 18 and older who may look like adults but often are still growing and maturing.
She treated young bariatric patients at Boston Children’s Hospital, and since arriving in Indianapolis a year ago with her husband, IU Health Methodist Hospital cardiac surgeon Lawrence Lee, she has talked about relaunching an adolescent program here.
Kimberly Wilkes, practice administrator for general surgery, said IU Health’s adolescent bariatrics program likely was phased out as the economy entered a tailspin in the late 2000s, which led to fewer patients seeking elective surgery.
Dr. Lee, a mother of two, divides her time between general and bariatric surgery at IU Health University Hospital and IU Health North Hospital. In addition, she runs the IU Surgical Skills Center, an educational facility focused on the development of surgical education and skills through simulation-based training.
“I have a teacher mentality, but I’m a surgeon,” she said. “There’s a growing number of us that have a master’s in education plus a medical degree, but it’s still pretty unusual.”
Despite not having a dedicated adolescent surgical weight-loss program within IU Health, Dr. Lee said she is beginning to see younger patients – not young teens – but 18-year-olds who, despite their legal age, are still a fragile population when it comes to surgical weight loss.
“I’m teaching within our program that we can’t expect an 18-year-old to be the same as a 28-year-old,” she said. “Adolescents might look like an adult – they might be my size, they might be bigger than me – but I can’t expect them to be me. I can’t say ‘you look like an adult so I’m going to treat you like an adult.’ ”
Often, this is the first time they’ve ever been hospitalized, she said. They might need to stay in the hospital longer than an adult after surgery even though they’re healthier. “They’re kids, they’re little humans still.”
An 18-year-old who is in high school would still need tremendous family support to be successful in a weight-loss program. For younger teens, it’s even more important.
“There has to be tremendous buy-in with the family,” Dr. Lee said. “If the child has weight-loss surgery, but the mom and dad are still making poor choices – they’re the people with the cars and the money – it will be difficult to be successful. Adults have more control.”
Gastric bypass surgery has the best weight-loss outcome but is a more radical surgery, Dr. Lee said, and is not ideal for younger patients. Lap-band surgery is less invasive but not as reliable when it comes to weight loss. The gastric sleeve is middle-of-the-road surgery with decent success rates, she said. The surgeries shrink a person’s stomach and alter hormones regulating hunger and feelings of fullness.
While there’s no timetable for expanding the bariatrics program to serve adolescents, it would require a multi-disciplinary approach and structure that makes it easier for young people to meet with a surgeon, dietitian, psychologist and gastroenterologist all in the same day so they wouldn’t miss too much school. Adolescents would go through a modified program with a team of specialists experienced in working with younger patients.
Adult bariatric patients are encouraged to lose a modest amount of weight before their surgery, but for a teen, that might be too big of a challenge, Dr. Lee said.
“Even an 18-year-old who looks like a fully grown adult is still growing while going through the program. If I tell her she can’t have surgery until she loses 25 pounds, she might never have the surgery because it’s just too hard.”
In Boston, Dr. Lee said, she and her partner operated on younger teens only when they had significant health risks. Otherwise, waiting is better, she said.
But helping young people live better lives remains one of her passions.
“Seventy-five percent of obese kids become obese adults, so it’s a problem that’s not going to go away,” she said. “Being able to change that for a young person so they can change the trajectory of their life to be healthier, more fit, more successful – the potential is outstanding.”
– By Maureen Gilmer, IU Health senior journalist
Email: mgilmer1@iuhealth.org
Photo by Mike Dickbernd, IU Health visual journalist
Email: mdickbernd@iuhealth.org