Dr. Sarah Armstrong has a 15-year-old patient who has been going to the weight management clinic at Duke since he was 8 years old.
“The parents both have worked with us tirelessly, the family drives an hour to see us, they’ve tired various diets and exercise, and he continues to gain weight,” said Dr. Armstrong, who is a professor of pediatrics at Duke University. The boy developed diabetes and became so large that his family took him out of school because he was a target for bullying. He now weighs 400 pounds, and the clinic is petitioning Medicaid to pay for bariatric surgery.
“If he had cancer and needed chemotherapy, no one would tolerate this,” Dr. Armstrong said. “People view obesity as the parent’s fault, the child’s fault,” and believe that the state shouldn’t be paying. So the clinic is faced with “these really sick children, and there’s a safe and effective treatment right down the street and I can’t get them there.”
For the first time, the American Academy of Pediatrics has issued a policy statement on bariatric surgery for adolescents. Dr. Armstrong was the lead author on the policy statement and a co-author on the accompanying technical report, which summarized all the available evidence about a form of surgery that is increasingly accepted as an effective therapy for adults, but is often regarded negatively for younger patients — including by their pediatricians.
The American Academy of Pediatrics has a new policy statement on bariatric surgery for adolescents.
“Twelve million kids in the U.S. have obesity and over four million have severe obesity,” she said, calling it “an epidemic within an epidemic.” We have not made the kind of categorical changes in our environment that might address this epidemic, she said, though we must keep trying. “These children aren’t just more overweight than their peers,” she said. “They’re sick.” Some of them are on insulin, others take one or more medication to control their blood pressure.
Most important, bariatric surgery seems to work well for adolescents with severe obesity. Over the past decade, Dr. Armstrong said, there has been a fair amount of research on bariatric surgery in people under 18. “It’s safe,” Dr. Armstrong said. “It’s effective — at least as effective as in adults.”
Like most pediatricians who have become involved with obesity and weight management, Dr. Armstrong did not go into this looking for surgical remedies. Her own research centers on getting children outdoors into nature. “I believe active physical exercise outdoors improves life, reduces stress,” she said. “This is what I love, it has nothing to do with surgery — but in my practice a lot of the kids can’t even get there because they’ve got such severe obesity.”
Children who have bariatric surgery, she said, reverse their medical complications very quickly. More than 80 percent of those who have been given diagnoses of Type 2 diabetes resolve after the procedure. Similarly, almost 90 percent of the cases of sleep apnea get better following surgery. The procedure also reverses high blood pressure, although not quite as effectively.
One of Dr. Armstrong’s patients, Faith Newsome, now a senior at UNC Chapel Hill, where she is studying psychology, said, “I personally have never known a time in my life when I haven’t carried excess weight.” She would bring her own sugar-free candy to sleepovers. She has stories of being bullied, of humiliation at field day.
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 overweight,” 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.
Life After Adolescent Weight Loss Surgery
11.14.2018 (Giving to Duke Health)