Adolescent Weight Loss Surgery: Pediatric Bariatric Surgery

What is pediatric bariatric surgery?

Pediatric bariatric surgery — also called adolescent weight loss surgery — is a weight-loss procedure that can help teens and young adults improve their overall health. It helps achieve a healthier body weight by changing how their bodies absorb and use calories and energy from their diets (how and what they eat).

Healthcare providers may recommend pediatric bariatric surgery when an adolescent’s weight threatens their health. It’s a safe and effective option for teenagers with severe obesity.

How common is weight loss surgery for teens?

Bariatric surgery among teens is uncommon, but it’s becoming more widely used.

There are about 14.7 million American adolescents with obesity. But fewer than 1 of every 5,000 teens have a weight loss procedure each year. These numbers will likely increase as more healthcare providers recommend pediatric bariatric surgery for adolescents with obesity.

How should I prepare for adolescent bariatric surgery?

Before recommending bariatric surgery, your provider will conduct a physical exam and order several tests. This helps determine whether you’re a good candidate for the surgery.

Blood tests will check:

• Blood glucose levels and A1C, to look for Type 2 diabetes.
• Cholesterol.
• Complete blood count (CBC).
• Liver function.
• Nutritional deficiency.
• Pregnancy.
• Thyroid function.

You also may have a sleep study (polysomnography) to determine whether you have sleep apnea. An X-ray or bone mineral density test determines whether your skeleton is mature enough for bariatric surgery.

You’ll meet with a counselor while considering surgery. They’ll help you prepare mentally and emotionally for surgery, recovery and long-term weight control. You’ll also meet with a dietitian and a physical therapist or exercise physiologist. They’ll help you set up a nutrition and physical activity program to set you up for long-term success.

Your doctor will recommend — and your insurance may require — that you meet with your medical team monthly for a minimum of six months to prepare for pediatric bariatric surgery.

What happens during bariatric surgery for an adolescent?

The American Academy of Pediatrics recommends two types of bariatric surgery for teens. Both types of surgery make your stomach smaller than it used to be. Surgeons perform these procedures under general anesthesia.

1. Gastric sleeve surgery (sleeve gastrectomy). A surgeon removes part of your stomach and creates a tube or “sleeve” with the remaining tissue. Your new stomach is smaller and narrower than your natural stomach. In addition to making your stomach smaller, gastric sleeve surgery reduces hunger hormone production.
2. Gastric bypass surgery (also called Roux-en-Y gastric bypass). A surgeon divides your stomach into two sections, creating a small pouch at the top. Next, they connect the pouch directly to your small intestine. This makes food and beverages bypass a large portion of your stomach and small intestine. The pouch becomes your stomach and holds much less food than your natural stomach. Bypassing part of the small intestine means your body will absorb less of the calories and nutrients in the food that you consume.

How long does pediatric weight loss surgery take?

Pediatric bariatric surgery usually takes a couple of hours. The sleeve takes less time and the gastric bypass takes longer. Afterward, you move to a recovery room, where your care team monitors you as you wake up from anesthesia.

What happens after weight loss surgery for childhood obesity?

You stay in the hospital for one or two days after pediatric weight loss surgery. During this time, your medical team will start you on a liquid diet. Once you get used to that, they’ll give you pureed (blended) foods. It can take as long as six weeks to work your way up to solid foods.

What are the indications for bariatric surgery in an adolescent?

Adolescent weight loss surgery can help you lose weight more quickly than diet and exercise alone. Achieving and maintaining a healthy weight can help you treat or prevent serious health conditions, such as:

• Bone and joint pain.
• Depression and social anxiety.
• Diabetes.
• High blood pressure (hypertension).
• High cholesterol (hypercholesterolemia).
• Liver disease.
• Menstrual problems like polycystic ovarian syndrome.
• Sleep apnea.

How successful is bariatric surgery for teens?

Weight loss surgery for young adults and teens can be very effective. But it’s not a guarantee that you’ll lose weight and keep it off. It’s also about a long-term commitment to exercising and eating nutritiously. Weight loss surgery is a tool that helps changes in diet (how and what you eat) and physical activity be more effective.

Studies show that 60% of adolescents lost 20% of their body weight or more and kept it off for at least five years. There are now studies that show bariatric surgery helps reduce body weight and treat complications for as long as nine years. Future research will tell us about very long-term results.

What are the risks or complications of weight loss surgery in teenagers?

Adolescent bariatric surgery has the same risks as many other surgical procedures. Possible complications include:

• Infection.
• Bleeding.
• Blood clots.
• An allergy to anesthesia.

But adolescent weight loss surgery also brings up additional considerations. Your body may take a while to adjust to eating much smaller amounts of food. You may experience the following symptoms because your stomach can’t hold what it used to:

• Dehydration.
• Hunger headaches as you get used to functioning on fewer calories.
• Heartburn.
• Nutritional deficiencies, which supplements may correct.
• Pain.
• Nausea and vomiting.
• Low blood glucose.
• Low bone density.

What is the recovery time after adolescent gastric bypass surgery or gastric sleeve surgery?

Most teens can go back to school in about two weeks. But your provider may limit your physical activity for about a month. You won’t be able to take gym class, play sports or lift anything heavy until you’re fully healed. You also should avoid getting pregnant for at least 18 months after bariatric surgery.

Over time, you should follow up with your primary care provider, nutritionist and counselor. They’ll help you maximize your physical health, get adequate nutrition and cope with the emotional aspects of weight management. If you lose a lot of weight, your provider may refer you to a surgeon for excess skin removal and body contouring.

A note from Cleveland Clinic

If you’re a teen with severe obesity, pediatric weight loss surgery can help. Gastric bypass or gastric sleeve surgery can help with weight loss and prevent long-term health problems. A team of physicians, surgeons, nurses, counselors and nutritionists support you through your journey to better health.