Experts now say bariatric surgery is safe for teens with obesity. One suburban 17-year-old tried it.
Health -- not appearance -- was behind 17-year-old Alejandra Hernandez's decision to do something drastic: She had bariatric surgery.
The weight-loss procedure, now recommended as a safe option for childhood obesity patients, that Alejandra underwent in March removed 80% of her stomach, revved her metabolism and helped the Aurora teen drop 72 pounds.
Now, instead of weighing 222 pounds, the 5-foot, 1-inch-tall Oswego East High School student weighs 150 to 153. She has the energy to play with her younger sisters, get more involved with clubs and find a new fashion sense -- in sizes and styles that truly fit. She no longer takes medication and is no longer prediabetic.
"I didn't have the surgery for looks -- not at all," she said about the procedure by Dr. Ann O'Connor, a pediatric surgeon and pediatric bariatric surgeon at Northwestern Medicine Central DuPage Hospital in Winfield. "It's a lot of nonscale victories that make it all that much better."
Victories for teenage patients who undergo bariatric surgery and overcome the disease of obesity can include reduced risk or avoidance of sleep apnea, osteoarthritis, Type 2 diabetes and liver failure, among other life-shortening conditions, doctors who perform the surgery say.
Another victory, doctors say, is the finding of a study published this fall in the journal of the American Academy of Pediatrics.
The study, by Penn Medicine and the Children's Hospital of Philadelphia, found bariatric surgery to be a "safe and effective strategy for groups of youth with severe obesity." Doctors use it as a reason to push insurance companies to cover the procedure for adolescents.
"There's 4.5 million obese teens out there with severe obesity, where no diet and exercise will ever address the issue," said Dr. Kristoffel Dumon, a bariatric surgeon and assistant professor of surgery at Penn Medicine.
"This is an open invitation to look more critically into surgery as a viable option. As surgeons, we definitely don't see surgery as a solution to the obesity epidemic; we see it as an option for patients or individuals that don't have any other medical options."
Alejandra and her medical team at Central DuPage decided she was out of options after roughly eight months in a medical weight-loss program, during which she lost 10 pounds -- down from 232. Her enrollment in the program came after she'd tried to lose weight unsuccessfully on her own for about a year and a half, going to the gym but never seeing results.
"I don't think it's the first go-to," Alejandra said of surgery. "If all your options have been exhausted, that's how it was for me. It was one thing that really did work."
She's not unlike the 4.8 million kids and teens ages 10 to 17 who have obesity, according to the 2017-18 National Survey of Children's Health. Obesity is a metabolic disease in which the body defaults to a higher than healthy weight, while hormonal and metabolic factors sabotage any efforts to decrease food intake or increase exercise by lowering the body's rate of caloric burn to correspond, O'Connor said.
She has treated 40 patients with bariatric surgery in four years and says those patients tried other strategies first. That's why O'Connor said she is pleased to have the backing of the new Penn Medicine study and the American Academy of Pediatrics to emphasize bariatric surgery as a solution worth considering for teens.
She said it's better to stop obesity before it has time to cause harmful effects to bones, blood-sugar management, digestion and other functions.
"Obesity is a disease; it's not a lifestyle choice. People that have the disease struggle, and they struggle throughout their lives," O'Connor said. "It makes sense to offer them the best treatment available, regardless of age."
The best treatment for patients who need weight-loss surgery is called the sleeve gastrectomy, doctors say.
O'Connor said she tells patients the procedure will remove 80% of their stomach and leave the remaining portion shaped like a banana. It will restrict, at least initially, the amount of food they are able to consume -- by virtue of limited stomach space -- and it will require them to take vitamins and adhere to a nutrient-dense diet, forever.
"You can regain all your weight, even after surgery. Everyone is different, and the metabolic consequences are complicated," she said. "This is not just, 'Have an operation and then off we go to McDonald's with our friends, we never have to think about it again.' It's an every-day-the-rest-of-your-life cognitive thought in order to stay successful."
The surgery helps by reversing the natural reaction of the obese body, and by helping metabolism stay the same or increase to burn more calories.
"By taking out the stomach, your metabolism does not slow down. You suppress hunger drive and you allow healthy eating habits to be accepted by your body," Dumon said.
Alejandra has been working on these changes for nine months since her surgery. Her family eats cauliflower rice instead of regular rice at meals and swaps out red meat for turkey or salmon at dinner.
Alejandra starts the day with an egg and turkey, if she has time, or a protein bar if she's in a rush. Lunch is typically a salad, and she's thankful the meals at school meet national nutritional guidelines.
"You have to really fit all those nutrients in because I really don't eat that much," she said. "I usually focus on protein and really getting those vegetables in."
It might seem risky to perform weight-loss surgery on a teenager, whose body may still be maturing. And it might seem counterproductive to operate on someone who isn't in full control of family meals, who soon will undergo the life changes of early adulthood and will be required to do so on a strict diet.
Dumon and O'Connor say they have heard these criticisms -- and others -- of teenage bariatric surgery. But they push back, saying the surgery has been proven not to stunt growth but to provide a range of health benefits for teens whose obesity is severe.
Both doctors say they don't consider the surgery for teenage patients unless their body mass index, or BMI, is at least 35, on a scale with a normal range of 18.5 to 25.
O'Connor said her patients typically have a BMI of 40 or higher -- Alejandra's was 41.9 at the time of her procedure.
Losing weight sooner can prevent those who are metabolically predisposed to obesity from suffering breathing disruptions during sleep if they develop sleep apnea, or from experiencing high blood-sugar if they develop Type 2 diabetes.
Alejandra's mother, Erika Ortega, said the surgery and lifestyle changes are working wonders for her daughter.
"Her health is fabulous," Ortega said. "She's mentally healthy, and overall I just think we wish we could have done it sooner so she could have been much healthier, more into sports and just a healthier version of herself."
Ortega works in medical billing and said she felt fortunate her expertise made it easier to navigate the insurance aspect of getting Alejandra the surgery, which the family's policy covered at 100%.
"If it was a non-covered benefit, that would have had to put a stop to everything," Ortega said, who joined O'Connor, Dumon and other doctors in calling for more insurance providers to include bariatric surgery coverage for teens. "I hope it opens up the mindset to the industry to help these children at such a young age and avoid any future issues."
Childhood obesity facts• Childhood obesity is a metabolic disorder, defined as having a body mass index, or BMI, at or above the 95th percentile for a person's age and sex, according to the Centers for Disease Control and Prevention
• 18.5% of kids in the U.S. ages 2 to 19 -- or roughly 13.7 million people -- have obesity, according to the 2015-16 National Health and Nutrition Examination Survey
• 14.8% of high school students in Illinois had obesity in 2017, according to the Youth Risk Behavior Surveillance System