Adolescents Grappling with extreme obesity resort to Surgery and recently approved weight loss medication

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As an infant, John Simon III was always hungry. As a toddler and young boy, he was known for his chunkiness. However, by turning 14, his weight escalated to a dangerous 430 pounds.

Nine months post a weight-reduction surgery that reduced his stomach size, John shed around 150 pounds, which considerably improved his health and boosted his optimism toward life.

“It felt like a fresh beginning,” John said, preparing to enter high school in California in the coming fall.

In Minnesota, Edward Kent, a high school sophomore diagnosed with fatty liver disease and weighing 300 pounds, started a course of the obesity drug Wegovy. He began the treatment just a month after federal approval for use in children aged 12 and older, and he has since lost 40 pounds.

“It’s tremendously significant, and it’s going to impact his life permanently,” expressed his mother, Dr. Barbara Van Eeckhout, an obstetrician-gynecologist. “It’s about his health.”

John and Edward are part of a gradually expanding group of young teenagers resorting to treatments such as surgery and innovative drugs that adjust metabolism to shed considerable weight. Critics advise against intervening at such an early stage, but these kids and their parents argue that these assertive – often expensive – approaches are needed after years of futile dieting and exercise regimes.

“John gave it his all,” said his mother, Karen Tillman, a 46-year-old accountant. “It’s not that he didn’t try. It was getting progressively difficult.”

Roughly 80% of teenagers who are overweight carry this burden into adulthood, leading to serious potential health risks and reducing their lifespan. The American Medical Association classified obesity as a complex, chronic disease ten years ago. However, Aaron Kelly, the co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, pointed out that effective treatments have not kept pace.

“Obesity is a disease driven by biology, not behaviour,” said Kelly. “We need early intervention. Waiting until later in life is too late.”

This January, the American Academy of Pediatrics released guidelines suggesting obesity drugs for children as young as 12 and surgery for those as young as 13. The suggestions were met with instant controversy.

Mental Health America, an advocacy group, described them as “dangerous” and “disheartening,” arguing that they would lead to increased eating disorders and continue to perpetuate harmful weight stigma. Some social media users accused doctors and parents of opting for the easy way out, blaming junk food or video games or even going as far as labelling parents as “child abusers.”

Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital, cautioned that the excitement over new weight-loss medications should not overshadow non-drug alternatives.

“Diet and exercise should continue to be the priority in obesity prevention and treatment, especially for children,” he wrote in JAMA.

But medical professionals treating severely obese kids insist that research conclusively shows diet and exercise alone are insufficient. Dr. Janey Pratt, a surgeon at Stanford University who performed John Simon’s surgery, noted that excess weight is associated with over 240 diseases, including liver issues, diabetes, and inflammation, and these symptoms appear early.

“By the time they reach me, it’s already affecting their major organs,” Pratt said. “You’re dealing with a runaway train.”

Despite his struggle with obesity, which led to joint pain, shortness of breath, severe sleep apnea, anxiety, and daily bullying at school, John attempted diets and exercise. He lost up to 40 pounds, but intense cravings ensured the weight always returned – often with extra. When he first met

 Dr. Callum Rowe, a pediatrics resident at a public health clinic at Children’s Hospital, Los Angeles, John’s body mass index was a staggering 75.

John, with a timid smile and soft-spoken nature, asked for help. He expressed his desire to embark on a “journey to wellness,” Rowe recollected.

Moved by his profound statement, Rowe referred John to the Stanford Medicine Children’s Health weight-loss program, a decision that led to the dramatic turnaround in John’s health.

Since the release of the AAP guidelines, registrations for the Stanford surgery program have doubled. Despite being among the busiest sites in the U.S., carrying out more than 50 of the annual 2,000 pediatric weight-loss surgeries, less than 1% of eligible children undergo metabolic surgery due to reluctance of doctors, lack of knowledge, or high costs, which can range from $20,000 to $100,000.

John was lucky as his surgery was covered by Medi-Cal, California’s Medicaid program, which sponsored 47 similar operations for kids aged 11 to 17 the previous year.

John lost about 35% of his body weight in less than a year. His liver function and insulin resistance improved, his arthritis symptoms reduced, and his sleep quality and mobility improved. Edward also responded positively to the obesity medication, witnessing a normalization in his liver function.

Both boys continue to face challenges but remain hopeful about their future. John, now 15, dreams of a happy, healthy life free from the weight that once consumed him. He aspires to be an automotive engineer and focuses on cooking healthy meals, working out regularly, and studying hard to achieve his dreams.

These cases highlight the severity and complexity of extreme obesity among adolescents and the significant steps being taken to address it. Even though these interventions come with challenges and potential complications, the immediate physical and psychological benefits appear life-changing for young patients. The transformation of John and Edward, backed by determined effort and medical innovation, presents a ray of hope for numerous teenagers grappling with similar issues worldwide. It’s a reminder that they can work towards healthier, happier lives with the proper support, tools, and determination.