Cuts in childhood obesity

Only a decade ago, most surgeons considered gastric bypass operations for teenagers unwise, given the risk of infection, pneumonia, and other complications from surgery and of vitamin deficiencies afterward — all for an operation that was not addressing an immediately life-threatening disease.

But, perhaps signaling a turning point in medicine’s understanding of childhood obesity and its long-term health dangers, stomach-reducing surgery for certain teens is gaining greater acceptance.

Children’s Hospital Boston, which runs a highly respected pediatric weight-loss program focused on healthy eating, this month opened a surgery program for 13- to 19-year-olds because of the growing number of adolescents who are extremely obese, weighing more than 300 pounds, and who fail even the best treatments doctors there can offer. Many of these teens already suffer from diabetes, high blood pressure, and other weight-related conditions that could shorten their lives.

“We see more and more patients who can’t drop the weight, who just can’t do it on their own,’’ said Dr. Lisa Summers, a pediatric gastroenterologist and nutritionist in Children’s Optimal Weight for Life program and medical director of the adolescent bariatric surgery program.

“Everyone wants to know why [doctors] are even thinking about doing these operations in kids,’’ echoed Dr. Bradley Linden, director of minimally invasive and computer-assisted pediatric surgery at Children’s. “We’re coming to the point where kids are suffering from the complications of their obesity, and these associated illnesses can lead to irreversible consequences.’’

Surgeons plan to operate on 20 to 25 teens a year who meet the program’s criteria, which include the maturity and motivation to stick with the lifelong post-surgery diet of eating only tiny portions of food and avoiding altogether some foods such as ice cream and soda. In the most common type of weight-loss surgery, the Roux-en-Y gastric bypass, doctors staple the stomach to create a small pouch that can hold just a few ounces of food.

Massachusetts General Hospital began a pediatric obesity surgery program in 2009, and has operated on 11 adolescents so far. Recently, lead surgeon Dr. Janey Pratt presented results from the first nine patients at a national conference for abdominal surgeons in San Antonio, showing that the operation cured diabetes, hypertension, and acid reflux in all patients, and that all had dropped significant weight.

None of the teens suffered immediate postoperative complications, though three had to have their gallbladders removed — gallstones are a potential risk of gastric bypass surgery — and all take supplements to stave off vitamin deficiencies.

Jesse Belrose, 18, of Cumberland, R.I., was one of Pratt’s first patients.

Jesse began to gain too much weight as a toddler, even though his mother, Lisa Belrose, said she provided him healthy food such as turkey and fruit. His weight climbed through elementary school, despite his love of swimming and playing soccer and basketball. “No matter how much he ate, he never felt full,’’ said Belrose. “When you hear your child crying ‘Mommy, Mommy, I’m hungry’ — it was horrible.’’

Jesse regularly saw nutritionists and psychiatrists, and enrolled in WeightWatchers. But by the time he turned 16, he weighed 430 pounds and suffered from diabetes.

Around that time, Belrose decided to talk to her son about a more drastic treatment. “I told him, ‘I was thinking about the bypass surgery. I don’t know if you’d be interested.’ He said, ‘Mom, I was afraid to ask you about it.’ ’’

Like many teens who decide to have weight-loss surgery, Jesse said he wanted to do it before college so he could have a fresh start. He also longs to play ice hockey — something his weight has prevented — and while he has always been popular, he is interested in having a girlfriend.

Jesse had the operation last April 12. He was 5 feet 10 inches and weighed 482 pounds. He said he was surprised by the amount of pain after the surgery, pain that made it difficult even to sip water. But after a couple of weeks, the pain dissipated and he gradually started to eat regular food. “I actually feel full now,’’ said Jesse, who is glad he had the surgery.

A year later, at his most recent weigh-in, he was down to 286 pounds. He no longer has diabetes or sleep apnea. Recently, he bought his first pair of regular Levi’s jeans, which he called a high point. “It made me happy,’’ Jesse said. “I feel like the same old me, just lighter and with more confidence.’’

Still, doctors caution, gastric bypass surgery is not for most teenagers carrying extra weight; about 32 percent of children ages 2 to 19 are overweight, meaning their Body Mass Index — a measure of body fat based on weight and height — is above the 85th percentile on the standardized Centers for Disease Control and Prevention growth chart.

Doctors at both Children’s and Mass. General say the surgery is only for teens whose BMI is above the 99th percentile — adolescents considered severely obese.

Tufts Medical Center found that insurers were a barrier to surgery in children. The hospital, which has a large adult weight-loss surgery program, had begun performing pediatric obesity surgery in the early 2000s and then stopped. “The gastric bypass is an operation that makes many families and pediatricians uncomfortable because of the long-term issues,’’ said Dr. Scott Shikora, chief of general surgery at Tufts and a bariatric surgeon.

While Massachusetts insurers generally do not pay for bypass surgery for teens, Pratt said Mass. General has persuaded insurers to cover the operation when the teen has a serious obesity-related medical problem.

She said, “There is still a pervasive attitude that severe obesity is under [a person’s] control, that it’s the child’s fault or the parents’ fault’’ and therefore the child can shed significant weight if he or she tries hard enough. But, Pratt said, a growing body of research pointing to genetic factors and even to exposure to hormones during the mother’s pregnancy is convincing doctors that severe obesity is a medical condition.

Falling mortality rates for adults — the death rate is now about .5 percent — undergoing obesity surgery also is widening acceptance of the operation for teens. Not enough operations have been done on adolescents to calculate a mortality rate, said Dr. Thomas Inge, the leading bariatric surgeon at Cincinnati Children’s Hospital Medical Center, which has the oldest and largest pediatric obesity surgery program. The hospital, which has done 160 operations since 2001, has had no surgery-related fatalities — though one boy died nearly a year after surgery from a bacterial intestinal infection Inge said was unrelated to the surgery.

Inge said pediatricians and parents are more concerned about long-term complications such as vitamin deficiencies and loss of bone density. A recent study by Inge and his colleagues showed patients did lose bone density, but, he said, their bones were abnormally dense before surgery. The hospital is now leading a 10-year study of 250 teenagers to look at vitamin levels. “Everyone is eager to see the long-term risk data,’’ he said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.