Obese teens find options with TGH+USF Health adolescent bariatric program

The obesity epidemic involves people of all ages, including the young. And just as eager as adults are to get their bodies back on track and avoid declining health and deadly conditions, many teens are starting to turn to bariatric surgery.

USF Health is expanding its adolescent bariatric surgery program, incorporating the same careful, successful approaches that have worked for adults for decades into a program aimed at younger patients.

“More and more teens are turning to bariatric surgery to enjoy its benefits now, in their youth,” said Sathyaprasad Burjonrappa, MD, USF Health pediatric surgeon who joined the TGH + USF Health Bariatric Center.

“There is greater acceptance and much more data validating the procedure for teenagers. And those benefits are just as obvious for this age group – reversal of medical conditions, halting some medications, and gaining a renewed investment in health. The word is getting out that childhood obesity can be halted and future adult obesity can be greatly curtailed with bariatric surgery.”

As the news media reminds us, obesity is on the uptick, increasing three-fold over the last two decades. Today, about 30 percent of adult Americans are obese. For children, the numbers reflect similar dim statistics – currently 20 percent of American children are obese, Dr. Burjonrappa said.

And, just as in adults, obesity in teens carries risks for comorbidities, he said, with increased high blood pressure, type 2 diabetes, obstructive sleep apnea, and metabolic syndrome that includes unhealthy cholesterol levels.

“The data and medical literature are clear,” he said. “If you are obese as an adolescent, you have a 75 percent likelihood that you will be obese as an adult.”

This dismal forecast looms large but may help push patients to commit to change at a younger age, he added.

Bariatric surgery for adults has been around for several decades and adolescent bariatric surgery has been available for more than a decade. Dr. Burjonrappa built a similar program at Albert Einstein University in New York prior to joining USF Health.

The biggest story for these teens, Dr. Burjonrappa said, is improved health.

Just as with adults, studies are showing that bariatric surgery can improve various chronic, debilitating health conditions, including diabetes, hypertension, sleep apnea, congestive heart failure, fatty liver disease, hyperlipidemia, heartburn, asthma, arthritis, and infertility.

Adolescent patients must meet the same criteria as adults to qualify for bariatric surgery. This includes having certain health conditions and comorbidities, along with a BMI (body mass index) of greater than 35, or a BMI of 40 with no comorbidities. Patients must be age 16 to 21; those who are age 14 or 15 will be evaluated on a case-by-case basis, Burjonrappa said.

Once qualified, adolescent patients take the same approach that has helped adults succeed with bariatric surgery: intense preparation from both a physical and emotional standpoint before surgery, and long-range support and follow-up after surgery.

“Surgery alone is not the answer,” Dr. Burjonrappa said. “For six to eight months prior to surgery, patients participate in monthly wellness programs that involve adolescent psychologists, exercise physiologists, and nutritional experts, so that the abnormal behavior/eating pattern is corrected prior to surgery.”

Also prior to surgery, patients must lose 1 to 2% of their weight and show a commitment to healthy behavior and eating in addition to participation in the wellness clinic. Many adolescents are evaluated by specialists to correct sleep apnea, control diabetes, and modify cardiovascular risk prior to surgery.

“This is a truly interdisciplinary approach to treating obesity,” Dr. Burjonrappa said. “Obesity is complicated and can only be treated successfully when we have a high level of attention on every issue that surrounds it. Patients are successful because we help them with every roadblock and issue they are likely to face. We incorporate all these disciplines to the help ensure an understanding of the life-long commitment and dietary regimen.”

The adolescent bariatric program is fully integrated into the TGH + USF Health Bariatric Center, a multidisciplinary Center opened in 2013 as a joint program of Tampa General Hospital and USF Health. The Center offers several procedures, including gastric bypass and sleeve gastrectomy.

Most of the time, adolescent patients receive sleeve gastrectomy, Dr. Burjonrappa said. In the 2000s, about two-thirds of patients received full gastric bypass. Now about two-thirds receive the sleeve gastrectomy.

“The surgery is short, and most of the time the procedures are performed under general anesthesia and laparoscopically,” Dr. Burjonrappa said. “And recovery is quick. Patients are in the hospital only a day or two.”

Follow-up is also rigorous, with bi-weekly appointments for about six weeks, then every month for three months, and then yearly.

“They must adhere to a strict diet, get exercise, and take supplements the rest of their lives,” he said.

Most patients’ pre-surgery weights are between 300 and 500 pounds – within one year, most are down to between 180 and 250 pounds, and no longer taking many, if not any, of their medications for comorbidities.

“Bariatric surgery in young patients is life altering,” Dr. Burjonrappa said. “After surgery, you see this confident teenager emerge again.”

Visit the TGH + USF Health Bariatric Center website for more information about bariatric surgery options available.