This article is part of Bariatric Surgery Helps Vibrant Teen Take Control of Her Health, NYU Langone Health News, Fall 2022.
When teens carry more weight than is healthy for their age and height, the consequences go far beyond appearance. Being affected by obesity early in life increases the lifetime risk for asthma, diabetes, and sleep apnea. It can cause earlier onset of heart disease through excess cholesterol and high blood pressure, and bone and joint disorders from excess wear and tear.
With so much on the line, pediatric obesity is a health condition that requires the same measured and personalized treatment strategy as any other illness. The team at the Adolescent Healthy Weight Program, part of Hassenfeld Children’s Hospital at NYU Langone, provides medically proven, compassionate, and effective obesity treatment for youths age 13 to 17 with a body mass index (BMI) of 35 or higher and an additional health risk factor, such as diabetes, or those with a BMI of 40 or higher without other risk factors.
Treatment begins with an evaluation from the program’s medical director, Emily Breidbart, MD. She talks with teens about any health issues they already have, such as diabetes, and their previous weight loss experiences. She asks about diet, exercise, and sleep habits.
When appropriate, she prescribes medications to help with insulin resistance, which is a precursor to diabetes and can make it harder to lose weight. Teens then meet monthly with the program’s nutritionist, who educates them on how to make healthier food choices. Youths who are not conditioned for exercise meet with a physical therapist from Rusk Rehabilitation, who helps them start a fitness routine that works for their bodies.
After six months of nutrition counseling, some teens still have considerable weight to lose. For them, Dr. Breidbart starts a conversation about bariatric surgery, which is performed by pediatric bariatric surgeon Jun Tashiro, MD, MPH, surgical director of the Adolescent Healthy Weight Program. If they are interested, the next step is an initial surgical evaluation followed by a psychological assessment from Becky Lois, PhD, co-director of the KiDS of NYU Foundation Integrated Behavioral Health Program at Hassenfeld Children’s Hospital. Dr. Lois assesses the teen’s mental health history, their understanding of the risks that come with any surgery, and how it will change their everyday eating patterns and behaviors around food.
“Bariatric surgery is such a huge life change,” says Dr. Lois. “Teens need to be motivated to make the diet and exercise changes that will make the weight loss sustainable. How will they handle lunch at school with their peers? How will they fit exercise into their routines? Is the entire family moving toward healthier eating, and if not, what are the barriers to target? I try to make sure that the child and family understand what’s expected of them after the procedure.”
Patients start a liquid diet before sleeve gastrectomy and maintain it for three weeks after as the stomach heals. Then come pureed foods, followed slowly by the reintroduction of solid foods. Each patient’s weight loss goal is based on their individual health history. But on average, if a patient had 100 pounds to lose, they could expect to lose 50 of that within 6 months after surgery.
“Patients come back beaming,” says Dr. Tashiro. “They’ve lost weight and want to keep it off, and work with our team to learn how to do that. Their improved self-confidence and motivation is the most gratifying part.”