Chapter 4 – Choice

Outpatient Weight-Loss Surgery, A Sasse Guide

Adolescents and Outpatient Weight-Loss Surgery

Adolescents and children present a particularly challenging subgroup for
health care providers, surgeons, parents and families. As surgeons, we
want to help, but we are also aware of the complexity of obesity as a
disease and its relationship to both the developing psyche and body of a
child or adolescent. There has been a good deal of research directed at
the topic of weight-loss surgery for adolescents, and the topic remains
controversial.78-81
On the one hand, people who emphasize the psychosocial aspects of
weight gain and unhealthy habits, decision-making and behavioral
aspects of this problem point out that children and adolescents have
developing brains and have a greater likelihood of changing their lives
and resolving weight problems without resorting to surgical procedures.
On the other hand, advocates for overweight adolescents point out that it
can be considered cruel to withhold valuable treatment for such a
devastating problem. They emphasize that the important years of
adolescence – high school and college years – are critical for the
formation of healthy relationships, self-esteem and career paths and that
these formative years set the compass for the direction of these young
people’s lives.

Adolescent Success
I have performed LAGB surgery on a number of adolescents with strong support
of their parents, pediatricians and psychologists. In each case, these adolescents
had tried everything to lose weight and understood the seriousness of their
decisions. One young man whose parents were both severely overweight felt that
he had no chance of attaining a healthy weight in high school without help.
Following the LAGB procedure he lost 70 pounds and has moved into his senior
year with a much healthier body and much healthier self-image.
It is also important to note that the entire recovery process for the out-patient
procedure takes about a week. For the young man in question, he was able to
have the operation during a break from school and not have to face probing
questions about taking a medical leave. The LAGB option allowed him and his
family to keep the decision private.
Adolescent weight-loss surgery will probably continue to be a debated
topic for years to come, but I think the most important consideration
must be the health of the adolescent. In unusual cases where a young
person is developing high blood pressure, liver disease and takes insulin
for diabetes, we are talking about life-threatening conditions. For other
adolescents, the problem of obesity is intertwined with social, behavioral
and mood problems and a terrible lack of knowledge about nutrition and
health.

Physically, adolescents are usually excellent surgical candidates for

medical procedures because they tend to be healthier by virtue of being
young. They have not had all the extra years to carry around or develop
all the extra weight and generally have not developed conditions such as
diabetes and heart disease.

The decision for a weight-loss procedure extends beyond cosmetic

considerations. With adolescents, a weight-loss operation is often
proactive – a procedure meant to pre-empt the deleterious physical
effects of being overweight that will most likely develop as the child
enters adulthood.

Our own approach at Western Bariatric Institute has been to perform

LAGB surgery for adolescents under the auspices of a research study
protocol.82 It requires that adolescents be seen, evaluated and approved
by a psychologist and pediatrician, as well as a parent, prior to entering
the program. Only the LAGB is offered, because our surgeons feel the fact
that the procedure can be reversed is important when the decision for
surgery is made for a minor.

In the past when the only surgical options available were more invasive
and more permanent procedures such as biliopancreatic diversion and
gastric bypass, it made less sense to offer weight-loss surgery to a wide
population of overweight adolescents. There would almost definitely be
complications to answer for, and the permanence of the surgical
intervention could certainly be questioned by those who point out that
minors do not have the same level of decision-making capability as
adults.

Some opponents of adolescent weight-loss surgery would also contend

that successful weight-loss surgery requires a high level of commitment
on the part of the patient. And since adolescents often lack the
experience and maturity to make such a deep commitment to lifestyle
changes and healthier habits, they should be made to wait a few years
until they reach adulthood.

Because the LAGB procedure has a track record of success, a compelling

case can be made to make it more available to adolescents. Just as for
adults, LAGB surgery is minimally invasive, requiring only a 30-to 40-
minute procedure, and is reversible with another fairly minimal procedure
and few adverse consequences. There are currently no standard criteria
for selecting adolescents for weight-loss surgery. Most centers that
perform adolescent weight-loss surgery will consider candidates with a
BMI of 35 or greater, as long as the parent and the child are committed
to long-term success, and the patient passes the psychological screening.

Purchase This Book:

Outpatient Weight-Loss Surgery: Safe and Successful Weight Loss with

Modern Bariatric Surgery.

Copyright 2009 – Dr. Kent C. Sasse

www.SasseGuide.com
 About the Author

Dr. Kent C. Sasse, M.D., MPH, FACS

K
ent Sasse, MD, MPH, FACS is a nationally renowned
authority on surgical weight-loss procedures and a
leader in the rapidly evolving field of bariatric surgery.
The distinguished recipient of several awards, including member-
ship in the prestigious Alpha Omega Alpha Society for top med-
ical graduates in the country, Dr. Sasse is founder and medical
director of both the iMetabolic International Metabolic Institute
and Western Bariatric Institute, a nationally recognized ASmBS
Center of Excellence.

The recipient of a bachelor’s degree in biochemistry at the Uni-

versity of California San Diego, where he graduated cum laude,
and two master’s degrees, including a master’s degree in public
health stemming from research related to biostatistics and bio-
ethics, from the University of California Berkeley, Dr. Sasse com-
pleted residency training in surgery, focusing on gastrointestinal
surgery and physiology, at the University of California San Fran-
20 O u t p a t i e n t W e i g h t - L o s s S u r g e r y , A S ass e G u i d e

cisco, as well as fellowship training at the Lahey Clinic in Bos-

ton, Massachusetts, before establishing his practice in northern
Nevada.

Dedicated to the highest levels of scientific research and

individualized, state-of-the-art treatment of patients, Dr. Sasse
brings a wealth of experience and expertise to the rapidly evolv-
ing field of weight-loss surgery. He has written and continues to
pursue several IRB-approved research protocols regarding weight
loss and weight-loss surgery, and he lectures frequently on top-
ics related to obesity and weight reduction at the University of
Nevada School of Medicine. Through his nationally recognized
programs, Dr. Sasse and his outstanding faculty provide patients
the highest levels of compassionate medicine, scientific evidence,
and personalized care in the field of weight reduction.

Please visit www.sasseguide.com for more information on Dr. Sasse

and his world-renowned programs and facilities.