The Bariatric Surgery team understands that being severely overweight can have a tremendous impact on a child's life - now and throughout adulthood. Our guiding principle is that bariatric surgery (also known as weight loss surgery) should only be considered after all other attempts at reaching a healthy weight have failed.
Weight loss surgery can be a safe and effective option for a child whose obesity has resisted all other avenues of management. However, undergoing such an operation will have a tremendous impact on their life, both immediately and for the long term.
The first step is a thorough education, conducted with your care and support team. As a primer, we've compiled the following F.A.Q. about the operations available at Children's and their long-term impact.
How does weight loss surgery work?
There are numerous different ways that weight loss surgery can be performed, but the end goal always remains the same: to lead to a healthier way of life. Two common ways to describe weight loss surgeries are by calling them "restrictive" or "malabsorptive."
Restrictive surgeries alter your appetite and amount eaten by closing off various portions of the stomach, thus altering your digestive system. As a result, smaller meals will make you feel full and decreases your food intake (and lowering the amount of calories, saturated fats, carbohydrates, etc.).
Malabsorptive operations simply create a detour in the digestive system to bypass a portion of one's small intestine. Your small intestine is responsible for the absorption of food and nutrients that you ingest during meals. By bypassing part of this process, less food is absorbed by your body.
Who is a candidate for weight loss surgery?
Indications for planned surgery, no matter the operation, are never a matter of a few simple rules. Bariatric surgery is no different. At Boston Children's, consideration for weight loss surgery is done on an individual basis after undergoing a complete evaluation by our team. Here are some guidelines we use:
- The candidate must have a BMI (Body Mass Index) of 35 or greater with obesity-related health conditions, or a BMI of 40 or greater without significant obesity-related health conditions.
- The candidate has been unable to lose weight through other dietary and exercise programs.
- In addition to the above criteria, the candidate is willing to follow all recommendations and requirements of the weight loss surgery program.
What kinds of weight loss operations are performed at Boston Children's?
There are different types of weight loss surgery. Most can be performed laparoscopically, wherein small instruments guided by a small telescope are passed through the body wall. The instruments are held and manipulated by the surgeon who controls their movements, while watching them on a video screen.
At Boston Children's Hospital, we offer two different options of laparoscopic weight loss surgery: the laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.
Laparoscopic Roux-en-Y gastric bypass
In this procedure a small pouch of the stomach is partitioned off from the rest of the organ. The remaining, larger stomach remains inside the body but is no longer used for digestion. The small stomach pouch empties into a channel created from a portion of the small bowel. The channel is called the "the Roux limb." The Roux-en-Y gastric bypass surgery has been performed for patients for more than 30 years. Since the a section of the stomach is now closed off, patients now get that "full" feeling after eating smaller portions of meals.
Illustration courtesy of Covidien
Laparoscopic sleeve gastrectomy
In this procedure, 85% or more of the stomach is resected (surgically removed). The stomach is stapled and divided vertically, significantly reducing its size. The portion of the stomach that remains is shaped like a banana.
Illustrations courtesy of Covidien
What are the responsibilities of an adolescent undergoing weight loss surgery?
A child's weight loss surgery is only part of their treatment plan. Their commitment to a healthy diet, and the family's support of this diet, are the most vital parts of the treatment. The diet he or she follows after surgery and for the rest of their life will determine their ability to control their weight. The gastric bypass diet may be very different from any other diet the child has followed in the past.
Although weight loss surgery is a viable option for many patients that cannot lose weight through normal diet or exercise, there are still dietary guidelines to follow. It is still possible to overeat and gain weight by eating and drinking high calorie foods instead of following a healthy diet. Our team will provide the support young men and women need to follow all the dietary and exercise recommendations, maximizing their chance of success in reaching and maintaining their healthiest weight.