Weight & Eating Problems

Like adults, lots of teens wish they could change something about themselves. Fortunately, in some cases — take hair, for example — that’s pretty easy to do. Kids can grow it long, cut it short, and if they don’t like it, a new look is just a quick snip or a few skipped haircuts away.

But certain things are not easy to change. For the 1%-2% of U.S. teens who are severely obese, losing those extra pounds can be one of them. For some, sticking to a doctor-approved diet and exercise plan is enough to lose enough weight to improve their obesity-related complications, such as diabetes, heart disease, or sleep apnea. But for others, even major lifestyle changes aren’t enough.

In these cases — where regular weight loss attempts have failed and medical problems persist — weight loss surgery or bariatric surgery might be an option.

About Bariatric Surgery

Bariatric surgery had its beginnings in the 1960s, when doctors first noticed that people who had portions of their stomach or intestines removed due to ulcers or cancer tended to lose a lot of weight after surgery, regardless of what they ate.

Doctors soon realized why: Not only could a smaller stomach hold less food at one time, but a shorter intestine couldn’t absorb as many calories and nutrients for the body to use.

The field of weight loss surgery has come a long way since then, but is still based on those same two principles:

1. Restriction: restricting the amount of food a person can comfortably eat by reducing the size of the stomach
2. Diversion: diverting food around a portion of the small intestine (usually about 2 feet) so that less is absorbed by the body. Diversion also changes the levels of hormones and enzymes in the digestive tract that signal hunger and fullness, so a person feels fuller sooner.

Types of Surgery

Today, there are three main surgical techniques for weight loss: gastric bypass, gastric sleeve, and gastric banding.

Gastric Bypass

Gastric bypass (also called “Roux-en-Y” gastric bypass) is the most commonly performed weight loss surgery. It involves creating a small pouch, about the size of an egg, at the top of the stomach using surgical staples or a plastic band. This pouch, which will serve as the “new” stomach, is then connected directly to the middle part of the small intestine (the jejunum).

So not only will the pouch hold a lot less food — just 1 cup as opposed to the 4 cups or more that a normal-sized stomach can hold — but the food will also bypass the larger part of the stomach and the upper part of the small intestine (the duodenum).

The pros of gastric bypass are that it has a high rate of success and a longer track record compared with the other options of gastric sleeve or gastric banding.

The cons are that even though it can often be done laparoscopically (using a few small incisions and a camera to guide the doctor’s movements instead of opening up the abdomen), it still involves cutting the intestine — which makes it a more complex procedure than banding, and therefore has more potential for complications and a longer recovery time. The lack of intestinal absorption also tends to cause vitamin deficiencies and, unlike gastric banding, the procedure is not reversible.

Gastric Sleeve

Gastric sleeve (also called sleeve gastrectomy) is the second-most common weight loss procedure. With this operation, the surgeon removes part of the stomach and creates a tube or “sleeve” from the remaining portion. This new, banana-shaped stomach is much smaller than the original stomach.

After the operation, a person will eat less, feel full sooner, and be less hungry. Unlike gastric bypass, a gastric sleeve operation only changes the stomach. This kind of surgery doesn’t divert food around part of the small intestine, so vitamin deficiencies are less likely.

Gastric sleeve surgery is less drastic and is easier to perform with fewer complications than gastric bypass. The gastric sleeve procedure is not reversible.

Gastric Banding

Gastric banding also works by decreasing the amount of food that can be comfortably eaten. An adjustable silicone ring is placed at the very top of the stomach to create a small pouch. Like gastric bypass and gastric sleeve, this band reduces the size of the stomach and makes people feel fuller sooner. Unlike bypass, though, banding does not interfere with food absorption in the small intestine.

The pros of gastric banding, which is done laparoscopically, are that it has a lower complication rate than the more invasive gastric bypass and gastric sleeve procedures, and vitamin deficiencies are less common because the intestine is not affected.

The band can be tightened or loosened to increase or decrease weight loss. Doctors adjust the band at periodic visits by inflating or deflating it through a port placed under the skin. The band may even be removed entirely if necessary, allowing the stomach to return to its normal size.

The cons are that it may not take off as much weight as the surgical bypass and sleeve options, and it may require replacement surgery later. Gastric band devices are not FDA-approved for people younger than 18. Though clinical trials are underway, most teens will not be able to get gastric band surgery.

Who Is a Candidate?

Figuring out if a teen is a candidate for weight loss surgery is a big decision that requires a team approach, including the teen, his or her family, doctors, nutritionists, and psychologists.

Generally, a teen’s body mass index (BMI) — the number calculated from a person’s height and weight that estimates body fat — should be 40 or higher, which constitutes severe obesity.

A teen with a slightly lower BMI (35 or higher) also may be a candidate for surgery if there are health problems like diabetes or obstructive sleep apnea. He or she must also be physically mature, which generally means at least 13 for girls or 15 for boys.

The team will consider other things, too: Is the teen healthy enough for surgery? Have other weight loss options failed? Does he or she understand what’s involved? Weight loss surgery is serious stuff — both physically and emotionally.

In fact, having the operation is only one step in losing weight. Teens need to build a new relationship with food — eating very small amounts, chewing thoroughly, and evenly spacing out food consumption throughout the day. For many, adjusting to this whole new way of eating and living in a “new” body can be overwhelming.

That’s why doctors take a cautious approach when it comes to weight loss surgery for teens, and only recommend it for those who have what it takes to make it a success: the motivation to make lifelong changes and the support of their family to help them do so.

Risks and Side Effects

Weight loss surgery, like any surgery, does come with risks. Uncommon but serious risks include:

• bleeding
• reaction to anesthesia
• infection at the incision site
• a leaky stomach or intestine that can lead to peritonitis, an infection of the abdominal cavity
• a blood clot in the legs or lungs
• bowel obstruction

Other side effects are more common and not quite as serious, but still unpleasant nonetheless. For example, many people who’ve had weight loss surgery have pain, vomiting, diarrhea, and acid reflux (heartburn) after eating — especially if they eat too much or too quickly. This is why they have to change their approach to eating. If they don’t, not only will they continue to feel sick, but in time they can regain weight.

“Dumping syndrome” is a problem associated mainly with gastric bypass. This is when food moves too quickly through the stomach and intestines, causing nausea, weakness, sweating, abdominal cramping, and diarrhea. Because dumping can be made worse by eating high-sugar or high-fat foods, teens need be especially careful about the types of food they eat as their bodies get used to a different mode of digestion. This can be especially difficult for teens, since fast food and sugary snacks can seem like their own food group at this age, and the pressure to fit in can make it harder to make good nutritional choices.

And last but not least, there are the emotional side effects. For example, it can be hard for some teens to figure out a new, healthy relationship with food, especially if they and others in their family have relied on food for comfort in the past.

Some teens may undergo an identity crisis of sorts and have trouble relating to others in their new, thinner body. And others have such high expectations — thinking that the surgery will boost their popularity or bring them more attention — that they’re disappointed to find that old problems still exist even at a smaller size.

To be sure, weight loss surgery is not a quick fix and is not considered an “easy way out.” There’s a lot of hard work involved. But for teens whose health is compromised by obesity and who are willing to make the commitment to a new way of life, the effort may well be worth it.

When my 14-year-old daughter and her friends are hanging out at our house, it seems like they’re always raiding the refrigerator! I didn’t think anything about it but then I heard about this thing called a binge eating disorder. What is it? And should I be worried?
– Hannah

Binge eating, also called compulsive overeating, is different from simply overeating now and then, like at sleepovers.

Teens with binge eating disorder feel a powerful urge to overeat, regularly eat large amounts of food, and don’t stop when they become full. They feel out of control and powerless to stop eating. Other signs of binge eating are feeling guilty or acting secretively about the large amounts of food eaten. Sometimes these binges are triggered by emotional stresses, which may occur with problems with friends, academic difficulties, or fighting with family members.

People who binge are usually overweight — even obese — because they take in so many more calories than their bodies can use. As a result, they may gain weight rapidly. They may feel bad about themselves, feel that they lack self-control, and feel bad about their bodies.

Your daughter may simply be overeating from time to time, but if you think she could have a problem with binge eating, talk to your doctor. Successful treatments are available that can help teens to feel better about themselves and to have a healthy relationship with food.

I have a 5-year-old son. Is he too young to start exercising?
– Dorea

Encouraging kids to be physically active is important at any age. In fact, kids who are active at a young age tend to stay active later in life — and have a lower risk of becoming obese or developing heart disease.

At 5 years old, your child will get exercise mostly from playing — running, playing tag, or kicking a ball around, for example. So make sure he gets plenty of time outside, away from the TV. And join in as much as possible. Not only will both of you enjoy the time spent together, but he’ll also benefit from the active example you set.

“What’s the right weight for my child?” is one of the most common questions parents have. It seems like a simple one, but it’s not always easy to answer.

Among kids the same height and age, some are more muscular or more developed than others. That’s because not all kids have the same body type or develop at the same time.

Growth and Puberty

Not everyone grows and develops on the same schedule. During puberty, the body begins making hormones that spark physical changes like breast development in girls, testicular enlargement in boys, and spurts in height and weight gain in both boys and girls. Once these changes start, they continue for several years. The average kid can expect to grow as much as 10 inches (25 centimeters) during puberty before reaching full adult height.

Most kids gain weight more rapidly during this time as the amounts of muscle, fat, and bone in their bodies change. All that new weight gain can be perfectly fine — as long as body fat, muscle, and bone are in the right proportion.

Because some kids start developing as early as age 8 and some not until age 14, it can be normal for two kids who are the same gender, height, and age to have very different weights.

It can feel quite strange for kids to adjust to suddenly feeling heavier or taller. So it’s perfectly normal for a child to feel self-conscious about weight during adolescence — a lot of kids do.

Figuring Out Fat Using BMI

Experts have developed a way to help figure out if someone is in the healthy weight range for his or her height. It’s called the body mass index, or BMI. BMI is a formula that doctors use to estimate how much body fat a person has based on his or her weight and height.

The BMI formula uses height and weight measurements to calculate a BMI number. Though the formula is the same for adults and children, figuring out what the BMI number means is a little more complicated for kids.

For kids, BMI is plotted on a growth chart that uses percentile lines to tell whether a child is underweight, healthy weight, overweight, or obese. Different BMI charts are used for boys and girls under the age of 20 because the amount of body fat differs between boys and girls and body fat changes as kids grow.

Each BMI chart is divided into percentiles. A child whose BMI is equal to or greater than the 5th percentile and less than the 85th percentile is considered a healthy weight for his or her age. A child at or above the 85th percentile but less than the 95th percentile for age is considered overweight. A child at or above the 95th percentile is considered obese. A child below the 5th percentile is considered underweight.

Before you calculate your child’s BMI, you’ll need an accurate height and weight measurement. Bathroom scales and tape measures aren’t always precise. So the best way to get accurate measurements is by having kids weighed and measured at a doctor’s office or at school.

What Does BMI Tell Us?

You can calculate BMI on your own, but consider asking your doctor to help you figure out what it means. Doctors do more than just use BMI to assess a child’s current weight. They also take into account where a child is during puberty and use BMI results from past years to track whether that child may be at risk for becoming overweight. Spotting this risk early on can be helpful because changes can be made before developing a weight problem.

Kids are developing weight-related health problems previously seen only in adults. Type 2 diabetes, high cholesterol, and high blood pressure (hypertension) are now commonly seen in overweight and obese kids and teens. They’re also more likely to be overweight as adults. And adults who are overweight may develop other serious health conditions, such as heart disease.

Although BMI can be a good indicator of body fat, it doesn’t always tell the full story. Someone with a large frame or a lot of muscle instead of excess fat (like a bodybuilder or athlete) can have a high BMI. Likewise, a small person with a small frame may have a normal BMI but could still have too much body fat. These are other good reasons to talk about your child’s BMI with your doctor.

When Kids Are Overweight or Underweight

If you think your child has gained too much weight or is too thin, a doctor should help you decide whether your child really has a weight problem. Your doctor has measured your child’s height and weight over time and knows whether growth is proceeding normally.

If concerned about your child’s height, weight, or BMI, the doctor may ask questions about your child’s health, level of physical activity, and eating habits, as well as your family medical history. The doctor can put all this information together to determine whether there’s a weight or growth problem.

If your doctor thinks your child’s weight isn’t in the healthy range, you will probably get specific dietary and exercise recommendations. It’s important to follow a doctor’s or dietitian’s plan that’s designed for your child. For kids and teens, significantly restricting calories or following fad diets or starvation plans can deprive them of the nutrients their growing bodies need and may actually slow down growth and sexual development.

What if your child is worried about being too skinny? Most kids who weigh less than others their age are just fine. They may go through puberty on a different schedule than some of their peers, and their bodies may grow and change at a different rate. Most underweight teens catch up in weight as they finish puberty during their later teen years, and there’s rarely a need to try to gain weight.

In a few cases, kids and teens can be underweight because of a health problem that needs treatment. If your child feels tired or ill a lot, or has symptoms like a cough, stomachache, diarrhea, or other problems that have lasted for more than a week or two, talk with your doctor. Some kids and teens are underweight because of eating disorders, like anorexia or bulimia, which need medical attention.

The Role of Genes

Heredity plays a role in a person’s body shape and weight. People from different races, ethnic groups, and nationalities tend to have different body fat distribution (meaning they accumulate fat in different parts of their bodies) or body composition (amounts of bone and muscle versus fat). But genes are not destiny — kids can reach and keep a healthy weight by eating right and being active.

Genes aren’t the only things that family members may share. It’s also true that unhealthy eating habits can be passed down. The eating and exercise habits of people in the same household probably have an even greater effect than genes on someone’s risk of becoming overweight. If parents eat a lot of high-calorie foods or snacks or don’t get much exercise, their kids tend to do the same.

The good news is these habits can be changed for the better. Even small changes, like cutting back on sugary drinks and going for a walk after dinner, can add up to make a real difference.

So remember, it’s not a specific number on the scale that’s important. It’s making sure that kids stay healthy — inside and out.