Really? Bariatric Surgery for Teenagers is What We're Doing Now?

CW: Discussion of weight-loss surgery and disordered eating

This week the journal Pediatrics published a policy statement from the American Academy of Pediatrics that argues more children and adolescents should have access to bariatric surgery.

I’m sorry, SAY WHAT NOW?? Why are any children or adolescents AT ALL having bariatric surgery?

If you’re not familiar, bariatric surgery is a procedure that changes the structure of your digestive system, either by making your stomach smaller or re-routing parts of it, so that you can’t physically eat as much and you absorb fewer calories. The surgeries can be invasive and carry post-operative risks, and they require permanent changes to a patient’s diet. After surgery, patients are restricted to a liquid diet for 2 to 3 weeks and then need to slowly add soft foods then solid foods. According to this information on Medline, after gastric bypass surgery, which reduces the size of the stomach, patients can only consume about a tablespoonful of regular food at first. Overtime, this will expand to a single cup of regular food, when an unaltered stomach can hold 4-times that much. Patients have to limit or eliminate their intake of fats, sugar, carbohydrates, and carbonated beverages and have to take supplements so they get enough nutrients. Some of the most common side effects of bariatric surgery are body aches, nausea and vomiting, diarrhea, feeling tired or cold, malnutrition, and ulcers, among others.

And we’re doing this to TEENAGERS. I’m 40 years old and I can’t imagine first having to undergo major surgery and then having to radically alter my entire lifestyle so as to completely restrict my food intake down to a few bites of low-fat dairy or skinless chicken breast, for instance.

And we’re not only doing this to teenagers already, a major medical association is recommending that MORE teenagers and children have access to it.

Source: https://pediatrics.aappublications.org/content/early/2019/10/24/peds.2019-3223

Children and adolescents with “severe obesity” (as determined by BMI, which we already know is a poor indicator of health) also are more likely to have additional complications like type 2 diabetes, fatty liver disease, and hypertension and are at an increased risk of developing these complications. And I am NO WAY suggesting that children with these conditions is a good thing or something we shouldn’t be addressing. I AM, however, horrified that instead of promoting greater racial and socio-economic justice to these underserved populations, instead of advocating for better access to healthier foods and the elimination of food deserts, instead of fighting to preserve open spaces and offer safe locations for children to get physical activity, this national group of pediatrics specialists recommends that more children be altered physically, often permanently, in order to do so.

My fear is that this recommendation will lead to an increase in disordered eating in adolescents because surgery will be used as a threat of last resort. “Lose weight, lower your BMI however you can or we’ll refer you for surgery. You won’t be able to eat any of your favorite foods ever again. Do you want that?” The AAP statement is very careful to exhort pediatricians to have meaningful conversations with their patients about the benefits and risks, to make decisions together with patients and family, and that bariatric surgery should not be undergone without taking into account psychological and developmental maturity. But they also say that the patients in one of the studies that supports their recommendation were majority white and female. Which just so happens to be the same population who is most likely to have an eating disorder.

I find this whole thing repulsive and disgusting, and my level of distress and anger over this recommendation is high. Personally, I think there are far bigger concerns out there for the health of children and adolescents (can we say climate change for one?) than access to bariatric surgery.