Surgical methods to combat severe obesity aren't for everyone, particularly children.
However, a report the American Academy of Pediatrics recently released provides evidence in many cases, surgical procedures can be effective methods in overcoming severe obesity in children and promoting healthier lifestyles.
The academy compiled studies consisting of people in a number of age groups (generally 12-28 - one study used a group whose median age was about 11.5). It focused on children whose body mass indices were above 35. BMI is determined through a weight-to-height ratio.
More than 30 percent of adolescents in the United States are obese. About 40 percent of adults are.
There are 4.5 million children in the country who are severely obese, according to the academy report.
"These children are at high risk for developing chronic and progressive diseases, including hypertension, dyslipidemia (essentially high cholesterol), obstructive sleep apnea, polycystic ovarian syndrome (a hormonal disorder causing enlarged ovaries), type 2 diabetes, fatty liver disease, bone and joint dysfunction, depression, social isolation, and poor quality of life," the report warns.
In Jefferson City, health care professionals encourage lifestyle change as the first step in overcoming childhood obesity, said Sarah Rembecki and Tara Kempker, pediatric nurse practitioners at St. Mary's Pediatric Outpatient Clinic, 3348 American Ave.
"We actually work from a health promotion and disease prevention framework," Kempker said. "We do a lot of education about health and wellness and increasing activities - decreasing excess calories like sugary beverages."
Staff at the clinic encourage physical activity and outdoor play as factors in patients' efforts to control their weight.
They try to set small goals for the patient and the family, Rembecki said. They encourage patients to journal their efforts. And they avoid words like "diet" and "fat," rather choosing to discuss nutrition in conversations with patients.
Education is an important part of the effort.
"A lot of it has to do with education - and people not understanding how harmful those things can be. They sometimes don't understand the importance of substituting fish for red meats," Rembecki said.
A small goal may be something as simple as walking for 15 minutes.
Sedentary lifestyles are difficult to overcome. There are so many things people do without actually doing anything, like watching television, playing video games or using their phones.
"There are kids who will spend hours on 'screen time' daily," she said. "Sometimes, we'll limit that to an hour or two hours - max."
If the effort doesn't seem to be affecting the child's weight, or if there are "comorbidities" affecting the patient (conditions brought on by obesity - such as Type 2 diabetes, high blood pressure and development of high cholesterol), the clinic likely will refer the patient to a specialist.
The clinic strives to stay ahead of health concerns that affect seriously obese patients. All patients are broadly assessed during "well child" clinic visits, Rembecki said.
Staff ask every child about things like sleep and stress, eating habits and activity levels. They look at weight and blood pressure during the visits.
When treating serious obesity in the clinic, staff want to know how much the weight is affecting the patients' lives, Kempker said.
"We're seeing more and more (normally adult conditions) like high blood pressure, diabetes and high cholesterol," Rembecki said, "in younger and younger patients."
Fewer than 1,600 adolescents receive surgical treatment for obesity in the United States each year.
Doctors commonly use three types of weight-loss surgery in the United States. Gastric bypass (GB) is the most common. In this procedure, surgeons create a small pouch from the stomach and connect the pouch directly to the small intestine. After the surgery, swallowed food goes to the pouch then directly to the small intestine, bypassing most of the stomach and the first section of the small intestine.
During vertical sleeve gastrectomy, another common surgical method for weight loss, the physician removes about 80 percent of the stomach, leaving a tube-shaped stomach about the size and shape of a banana, according to online information from The Mayo Clinic.
The third common form of weight-loss surgery is reversible. A laparoscopic adjustable gastric banding procedure uses an inflatable balloon placed around the upper part of the stomach and affixed in place. The band creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach. The band restricts the amount of food stomachs can hold, helping patients feel fuller sooner.
The banding procedure has declined in use among adult and adolescent patients because of limited long-term effectiveness and higher-than-expected complication rates.
Results of adolescent use of the procedures have been promising, according to academy data. Overall, youths who underwent the procedures lost about 27 percent of their weight within three years. They also had significant reductions in comorbities.
Their cardiovascular disease risk factors dropped sharply.
"Surgical treatment is more effective than medical therapy among adolescents with severe obesity for treatment of type 2 diabetes," the report states. "Weight-related quality of life has also been shown to improve significantly."
One study the academy looked at reported follow-up data five years after the procedures.
The median weight loss for participants five years after their procedures was more than 81 pounds.
"By contrast, adolescents enrolled in lifestyle modification demonstrated a mean increase in BMI of 3.3 points," the academy reports.
Effectiveness of the procedures varied after the first six months, with LAGB (5.4 percent BMI decrease) being on average least effective, followed by VSG (11.5 percent BMI decrease) and RYGB (18 percent BMI decrease). Data collected after 36 months showed those who underwent LAGB had continued improvement to their BMI scores, while those who underwent the other procedures maintained their scores.
Data supports the use of surgical procedures to treat severe obesity in adolescents, the academy holds.
"Severe obesity in children and adolescents is a worsening health crisis in the United States," the academy said. "Unfortunately, severe obesity has few effective treatments.
"Improved access to metabolic and bariatric surgery for pediatric patients with severe obesity is urgently needed."