STANFORD, Calif-- Surgeons at Lucile Packard Children’s Hospital (LPCH) last week performed the first bariatric surgery at a California children’s hospital, signaling that morbidly obese teens in the state will now receive care at an institution designed to address their special needs.
 
Until now, teenagers eligible for bariatric surgery in California turned to surgeons at adult hospitals and bariatric surgery clinics. But physicians at the LPCH Center for Healthy Weight believe the surgery of last resort should be available in a pediatric context.

“It’s paramount that adolescent specialists care for these children in kid-centric facilities,” said Craig Albanese, MD, who is chief of pediatric surgery and surgical director for the Center for Healthy Weight at Lucile Packard Children’s Hospital and a professor of surgery at the Stanford University School of Medicine. “This is not a quick-fix operation. This is a tool that helps people achieve a more healthy lifestyle and it requires an appropriate support system for the patient and the family.”

The surgery will only be performed on a very selective basis on a limited number of patients who meet stringent criteria, said Lawrence Hammer, MD, director of clinical programs at the Center for Healthy Weight and professor of pediatrics.

Albanese explained, “We’re only going to operate on the most severely ill of the severely obese adolescents.”

Harvey Cohen, the hospital’s chief of staff and chair of the Department of Pediatrics at the School of Medicine, said the bariatric program is one piece of the hospital’s comprehensive program for healthy weight. “We are committed to helping children and families deal with what we consider one of the biggest epidemics in pediatrics today—the epidemic of childhood obesity.”

One-half to three-quarters of all obese adolescents will carry their obesity into adulthood and 80% of those with at least one obese parent will follow in their parents' footsteps. All such teenagers have an increased risk of developing serious or life-threatening conditions, but some already suffer from serious obesity-related illnesses. These are the teens who may be eligible for bariatric surgery.

On Nov. 9, Albanese and John Morton, MD, assistant professor of surgery at Stanford and director of its adult bariatric surgery program, performed the surgery called a Roux-en-Y gastric bypass on an obese adolescent.

“We reduced the patient’s stomach to a pouch the size of a walnut such that, initially, it will hold just one tablespoon of liquid,” Albanese said. Separating the rest of the stomach from the smaller pouch has a hormonal effect that causes patients to be less hungry. “The combination of less craving for food plus restricted intake causes weight loss,” he said.

At age 18, Albanese’s patient weighs 270 pounds, has a body mass index of 44 (a BMI of 20 to 24 is considered healthy), and has struggled with her weight since kindergarten. “I have been through every weight-loss program you can name,” she said. She suffers from headaches, blurred vision, back and knee problems and restricted breathing, all brought on by her weight. And she’s at high risk of developing Type-2 diabetes—a disease her mother has.

Her mother wants a healthy adulthood for her child. “I’ve been obese all my life,” she said. “I have tremendous health problems. I don’t want this life for her.”

Before instituting an adolescent bariatric surgery program, LPCH established clear guidelines for patient eligibility. Albanese and Hammer co-authored a paper, published in the journal Pediatrics last July, outlining appropriate steps for deciding which severely obese adolescents would be good candidates for surgery.

At LPCH, teens seeking bariatric surgery must have a body mass index (a defined relationship between a person’s height and weight) of more than 40. The teen must also suffer from at least one of three severe obesity-related illnesses: Type-2 diabetes, obstructive sleep apnea or pseudotumor cerebri, a condition in which pressure in the cranium causes headaches and vision problems.

In addition to having severe physical ailments due to obesity, bariatric surgery candidates must have completed 90 percent of their growth, have a supportive family, and present objective evidence of a diet and exercise program that has failed.

“It’s fundamentally a life-changing procedure,” said Hammer. “It has long-term implications for the way the patient will eat and relate to others. The changes required of the family are fairly extraordinary.”

Patients must demonstrate that they will adhere to strict dietary and exercise guidelines after the surgery. According to Albanese, “If they can’t do what we’re asking before surgery, then they won’t succeed after.”

Albanese describes this patient as a “poster-child” bariatric surgery candidate. “She has been in our program for over a year, adhered to the diet regimen we gave her, kept a nutrition record, followed an exercise program, has a supportive family, and despite all this, she couldn’t lose weight,” he said.

The teenager said she looks forward to not hurting in her head, knees and back, and to feeling more comfortable and confident.

“People are so ignorant when it comes to obesity,” said her mother. “Telling my daughter to see a psychiatrist and go on a diet is like telling someone with cancer to put a Band-Aid on it. Obesity is a chronic disease. It’s like cancer, it just kills in a different way.”
 
To find out more about the bariatric surgery program at Lucile Packard Children’s Hospital, please visit http://bariatricsurgery.lpch.org.
 
About Lucile Packard Children's Hospital
Lucile Packard Children's Hospital at Stanford is a 264-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with Stanford School of Medicine, LPCH offers patients locally, regionally and nationally the full range of health-care programs and services – from preventive and routine care to the diagnosis and treatment of serious illness and injury. To learn more about Lucile Packard Children's Hospital, please visit our Web site at http://www.lpch.org.