SPRINGFIELD – Recently launched weight loss surgery at Baystate Children’s Hospital could mean the end of a life of chronic health problems for teens struggling with severe obesity.
Dr. Michael Tirabassi started laparoscopic gastric sleeve removal in patients between the ages of 15 and 20 years. It can help reverse severe obesity when behavior and lifestyle changes have not made the necessary weight losses of 100 pounds or more possible.
It involves the permanent removal of a large part of the stomach and has been performed on adolescents in other hospital systems, but only in the last few months by Tirabassi as part of the pediatric weight management program at Baystate Children’s Hospital. It comes at a time when obese teenagers are increasingly being treated for a range of related medical problems, from type 2 diabetes to sleep apnea to high blood pressure.
Previously, young patients waited in the weight management program led by Dr. Rushika Conroy who wanted bariatric surgery until she was 18 for anyone under 18 in western Massachusetts.
Conroy said that it is estimated that around 20% of the pediatric population are obese and between 4 and 6% are considered morbid obesity. It is these severely obese teenagers who must lose 100 pounds or more who will benefit from bariatric surgery to help with sustained weight loss and reverse the disease’s risks for developing long-term chronic conditions, she said.
Tirabassi, a seasoned pediatric surgeon, met with Baystate adult bariatric surgeon Dr. John Romanelli, Teamed Up to Prepare to Perform Pediatric Weight Loss Surgery.
“The problem with weight loss for teens and adults is that people with short-term weight loss can be successful quite often,” said Tirabassi.
He added, “You are dieting and losing weight. However, the success rate of sticking to the diet forever is very low and the weight will be gained again. The real role of bariatric surgery for the pediatric and adult populations is not only to lose weight, but to be successful in long-term weight loss. Keeping the weight off for the rest of their lives is what we are looking for. That is the success we are looking for. “
The weight loss surgery “takes anywhere from 45 minutes to two hours, depending on the patient, and they are usually in the hospital two nights after the surgery,” said Tirabassi.
He stressed that the operation now being offered at Baystate Children’s Hospital is “a small part of a comprehensive adolescent obesity program” and that “none of the adolescents are operated lightly.”
“The obesity program itself is one that we have had for a while, and surgery has only recently been added,” said Tirabassi. “Patients typically participate in the program from six months to a few years, meeting with the pediatric endocrinologist, nutritionist, and psychotherapist, and working on their weight loss goals before reaching a point where they’re ready for surgery.”
The mother of a local patient who was 16 years old at the time of surgery eight months ago said her daughter has since lost 50 of the 80 pounds she needed and her “blood pressure has gotten much better.”
“We have struggled with her weight since she was born,” she said. “She tried doing the Mighty program at Baystate Children’s when she was only 8 or 9 years old. At the time, she couldn’t lose weight and we tried other weight loss approaches. She just didn’t pick up. “
The woman, who asked for privacy to discuss her daughter’s struggles with obesity, called the operation a “last resort”.
“This is the last resort for parents and children going through this struggle,” she said. “Nobody should get involved. This should read: ‘We have not achieved anything with any other weight loss.’ “
She added that she was “as worried as any mother if her child goes under the knife,” but that her daughter “did very well” and continues to adjust day in and day out to the dietary changes resulting from the operation.
“It’s not like you have an operation and all your weight just falls off,” said the mother, who had gastric bypass surgery 10 years ago. “Don’t do it and she learns that and that it’s a lot more work than expected.”
Her daughter, an honorary student with a full-time summer job, agreed, saying a few days would be “tough.” Certain foods that she likes are now killing her stomach, and the emotional transition to a new diet can also cause stomach pain. However, she said she was getting used to it and appreciated Tirabassi for his “friendliness” as a medic who understands and treats her illness.
“Yes, overall it was worth it,” she said when asked about the bariatric operation.
The start of the coronavirus pandemic 19 months ago slowed the introduction of laparoscopic surgery into the pediatric program, but Tirabassi said he has performed the procedure, which is considered low-risk and minimally invasive, on about half a dozen patients so far.
He sees his patients “quite a lot” both before and after the operation.
“Two or three times before surgery and several times in the release process,” said Tirabassi, “and then two weeks after surgery for routine wound control and then a month outside, and then three months and then six and then annually.” For a while . “
Tirabassi said that the decision to offer surgery “data that supports their usage and practice patterns” will be reviewed.
“The American Society for Metabolic and Bariatric Surgery has published guidelines on the use of bariatric surgery in both adults and adolescents,” said Tirabassi. “You define the eligible young population as 13 years old and aspiring. In the way we think here at Baystate, we don’t really want to have the operation on anyone under 15 or 16 unless their operation was a very special case. “
He said that patients “really need to be involved in the process for success”.
“Every child is different,” said Tirabassi. “But when I meet with the youngsters, it seems like at 16 they really have that emotional maturity to get involved in the process and be successful.”
Tirabassi said the surgery, the laparoscopic gastric sleeve incision or gastric sleeve removal, “removes about 75 to 80 percent of the stomach and is a permanent, irreversible change in the body.”
The decrease causes a person to feel full sooner and also results in lower amounts of the hormone ghrelin, which goes to the brain to stimulate hunger, when the stomach is empty.
Tirabassi said that “a few weeks before the operation, patients must be on a liquid diet and continue this diet with liquid food until they are two weeks before the operation, and then start some type of baby food diet.”
“That helps them to adapt to the new shape of the stomach,” says Tirabassi. “Usually, after a month or two after the operation, you can finally eat normally again. But they have to eat smaller meals more often and choose their food very well. “
“It does,” he added, “requires a pretty dramatic change in lifestyle.”
Tirabassi said that “most of the patients I saw in the consultation have about 100 extra pounds that they need to lose to achieve ideal body weight,” and that unlike adults who face such an operation, seem to have “more complications from obesity”.
“The youngsters seem a little sicker and have more complications from obesity,” said Tirabassi. “They have diabetes a little more often, problems with joint pain and walking.”
He attributed this to “the nature of the referral process”.
“There’s this mindset that teenagers are not eligible for bariatric surgery,” said Tirabassi. “It’s only the teenagers who are in really bad trouble that their caregivers think about and turn to, but there is actually current data in the literature that not only do the obesity surgeries really well, but also metabolically better address. “than the adult population.”
According to Tirabassi, patients can lose about half their extra weight in the first two years after a gastric sleeve resection.
“This is a really dramatic difference in terms of her body,” he said. “It’s easier for them to take part in activities, and the biggest thing after having bariatric surgery is that the success rate at maintaining that weight is high.”
Tirabassi said a number of factors, including a genetic component, lead to obesity in children and can put a young person at risk for shortened lifespan without surgery.
“The morbidly obese teen is well on the way to becoming super morbidly obese and disabled in their 20s and 30s,” said Tirabassi. “Breaking this cycle sometimes takes something dramatic and sometimes bariatric surgery is just the thing to break this cycle.”
He added, “Reversing something like diabetes, which in and of itself has so many complications, is one of the biggest reasons for me to have bariatric surgery.”
“These teenagers may have a long life ahead of them and their lives can be so different after the operation,” said Tirabassi. “You lose enough weight to feel healthy and start exercising again. There aren’t many ways to change a person’s life so dramatically, but this is one of them. “