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    Monday, February 05, 2007

    Bariatric Babies: Looks like the next up and coming trend is weight loss surgery for children. Some say not so fast:

    "I don't think altering the human digestive tract is a solution to the problem of excess weight," said Joanne Ikeda, a nutritionist emeritus at the University of California, Berkeley. "It's one of these quick-fixes that isn't a fix at all."

    Doctors, she said, still know relatively little about the long-term effects of such operations on the very young.

    That's for sure. Here are some of the long term effects we do know about:

    The federal Agency for Healthcare Research and Quality released a study in July that said four in 10 weight-loss surgery patients develop complications within six months. Among adults, mortality rates among gastric bypass patients remain at between 1 in 100 and 1 in 200 patients.

    Laparoscopic gastric banding has been shown to have a much smaller death rate _ about 1 in 1000 patients _ but complications do occur.

    Of the patients who participated in the NYU study, two needed a second operation to adjust a slipping band; two developed hernias; five got an infection; five suffered mild hair loss and four had iron deficiencies related to their new diet. After the study was complete, one patient asked to have her band removed because of discomfort, said Evan Nadler, a pediatric surgeon and co-author of the study.

    Nadler said those complications were minor compared to the chronic diabetes and cardiovascular disease teens would face if they remained that heavy into adulthood.

    That's easy for him to say, but no one really knows if that's true. The end result of bariatric surgery is surgically induced malnutrition:

    Gastric bypass essentially results in surgically enforced, very low-calorie, low-carbohydrate dietary intake, thus requiring attention to adequate (>0.5 g/kg) daily protein intake. Micronutrients, including calcium, vitamin B12, folate, multivitamins, thiamine, and iron (for menstruating female subjects), must be supplemented after gastric bypass. A bariatric dietitian who is familiar with the progressive addition of food items with more complex compositions and consistencies can help with meal planning and nutritional "troubleshooting" as recovery proceeds. Finally, nonsteroidal anti-inflammatory medications should be avoided, to reduce the risk of intestinal ulceration and bleeding.

    Several of my patients have had bariatric surgery, two of them over thirty years ago when it was a rarity. Some of them sailed through splendidly and are living happily ever after as thin people. Some of them are not doing so plendidly, even though they had the same surgeons and the same procedure. One lady passes kidney stones every couple of weeks. Another regurgitates anything solid that she tries to eat and yet has only lost 20 pounds in six months. She says she makes up the calories in liquid. Another can not eat more than one slice of toast at a time without getting sick. Some have chronic diarrhea. Many have nutritional deficiencies. A couple have gained their weight back after 10 or 20 years. And yet, not one of them says they regret having the surgery, such is the praise they get from others for losing weight. If asked, every single one of them would call themselves healthier, but from my perspective their health is worse. They all require more monitoring and more interventions than they did before having the surgery.

    It's the height of arrogance, however, to push this medically induced malnourished state on a still developing and growing child. We don't know what damage we may do in the long-run to their bodies or their minds with these procedures.

    posted by Sydney on 2/05/2007 09:05:00 PM 0 comments


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