Friday, February 22, 2008

Kids and WLS, Part One: Introduction, and Physical health concerns

There is a growing movement on the part of the bariatric surgery industry to get approval for performing weight loss surgery on children in the US--and to get insurance companies to pay for it. Currently, if a minor wants WLS, they go to Mexico and pay thousands of dollars out of pocket for the procedure. I am going to state unequivocally that I believe that performing bariatric surgery for the purpose of weight loss on children is physically and psychologically harmful, and its approval in the US could lead to disturbing social implications. Because this topic is so involved, and so important, I am going to break it up into separate articles dealing with the various factors.

Physical health is the most tangible reason to oppose WLS for kids. Disturbingly, while it is potentially very physically harmful, WLS is frequently regarded as necessary for a fat person's health. Fat people are told that they will die unless they get bariatric surgery. Parents are told that their fat children will die before they grow up unless they receive bariatric surgery. Not only is this just plain bullshit, it's deadly bullshit.

First, there's the possibility of death and complications arising from the surgery itself. I am not going to rehash everything that Sandy wrote, but I want to say this: Considering that nearly five out of every one hundred people who get bariatric surgery die within a year afterwards--five people that would have been alive a year later (barring accidents and other random factors) had they not been convinced that it was better to be dead than to be fat. Maybe an adult can make the decision to take that risk for his or her own life, but allowing a child to take that risk is abominable.

Let me put this very, very simply: Children are not going to die "of fat" before they reach the age of consent.

"But, Rio, what about the 300-lb eight year olds we heard about on the news?"
What about them? For a kid that age to be that size, there has to be an underlying factor that caused them to be that size. Bariatric surgery is NOT going to solve that problem, and will likely just complicate their health problems further. Why are doctors so eager to carve children up and wreck their digestive tracts instead of, oh, I don't know, testing them for celiac disease, hormone problems, kidney disease (which can cause fluid retention--no amount of bariatric surgery will stop you from retaining water), or any number of issues that can cause abnormal weight gain? And if the child is found to be healthy, then why are we chopping out healthy stomachs because the children aren't the "right" body size?

So, let's set aside the problem of WLS itself being inherently dangerous, and the reluctance of doctors to see past fat tissue and find real medical conditions, and think about growing children.

Kids grow. At least, they should--and if they aren't growing, most people would regard that as a serious problem. Children who has been malnourished are often stunted and have developmental problems. Girls who don't get enough to eat often don't have periods, because their bodies are trying to conserve energy for survival purposes, saving their lives during a famine so they can reproduce when there is plenty of food. Also, if adult WLS recipients have a high rate of osteoporosis (and they do), then what do you think happens to children whose bones are still growing? Do we need to induce beriberi, chronic vomiting, peripheral neuropathy, and malnutrition, all possible consequences of WLS, in children?

Next, I want to tell you that you are a fathead. No, really: Your brain contains a great deal of fatty tissue--about three pounds of it, in fact. The neurons in your brain have protective sheaths made of fatty tissue, and that's just a part of the fat content up there. Research is indicating that deficits of certain fatty acids in the brain (DHA, for example) can lead to mental imbalance, brain diseases, and impared cognitive ability (that means lower IQ, y'all). Babies who are breast-fed get more fatty acids in their diet, and studies indicate that they tend to have higher IQs and better problem-solving ability.

Your brain, all by itself, has the capacity to burn up to 2000 calories per day. (Edited to add: That is a high estimate, please read comments) Imagine, then, a young person who has undergone WLS: They are not only getting enough food to fuel the continuing growth of their brains, they aren't even getting enough for proper functioning of their brains. How do we expect them to learn and grow on the miniscule amount of calories a WLS recipient can ingest? I suppose, however, given the current climate of "Intelligence isn't important; only people with perfect bodies have any value", having underdeveloped and undernourished brains isn't considered to be a negative thing.

Long story short, the physical risks of performing WLS on people who are still growing and learning are much too high to warrant the relatively superficial benefits. Kids aren't going to die from being fat if they don't get WLS, and any doctor who says otherwise is looking to make a buck off of the parents. Kids do have a serious increase in their risk of dying young if they get WLS, though, and that should be enough to convince parents to say NO to WLS for their kids. It isn't, though, and that's why I will continue on with this series. Next up:

Psychological health concerns.


AnnieMcPhee said...

According to the Cincinnati's WLS site they say that teens are eligible if they are over 40 BMI and have other factors (such as BP, cholesterol, diabetes, blah) and they have previously attempted other weight loss efforts. How young *are* they allowed to perform it, I don't know. I know I read recently that they were recommending it as young as 5 but that wasn't in the US.

AnnieMcPhee said...

The now infamous mom who made a tv spectacle of smuggling off her 13 year old to Mexico did it to avoid the "red tape" involved here - little things such as sleep apnea tests (so they don't die under anaesthesia) and psychological tests. You know, silly little inconveniences like that that they make kids undergo in the US to have the surgery.

Harpy said...

Excellent post.

What's happening here in Australia is similar, though they push the gastric band (lap band) surgery rather than gastric bypass. And apparently that makes it just fine and dandy because it's reversible, in theory. (Though I believe the manufacturer of the device only guarantees its removability for five years. I'll have to investigate that.)

The AMA (Aust. Medical Association) is strongly pushing for the surgery to be covered under Medicare so that fat children and adults can get it at low or no cost - currently it's only available in private clinics and costs a lot. But we have to slap the band on the fat kids before they die of TEH DIABEETUS and TEH FATZ OMG.

Sure, it might not be as invasive and devastatingly bad for you as gastric bypass, but it's essentially a surgically-enforced eating disorder. There's all this outrage and concern and hand-wringing over children and teens with eating disorders, and yet many of the same people are quick to agree that young fat people should be having surgery to induce the same effects.

It's sickening.

observer said...

"Your brain, all by itself, burns over 2000 calories per day."

That is telling: I had no idea that the brain burns as much as the "standard" daily allowable calorie figure (2000kcal/day) pushed at us by the "experts".

That same "too low" calorie intake when it's perpetually enforced by WLS is known to result in cognitive deficits, memory problems, and mental illness! (I am not getting into all the other deficiencies and co-morbidities of perpetual starvation here.) It's bad enough when adults are "convinced" to starve their brains (and the rest of them) to lose weight by any means. To force that miniscule energy intake on growing children through WLS? The kids who are so 'treated' might as well be sentenced to death...and all too many of them will die because some doctor decided to use the fact the kid is or appears to be fat as a "wastebasket" diagnosis.

Karen said...
This comment has been removed by the author.
Karen said...

The number I'd always heard for brain energy consumption was ~20% of your total energy consumption. So, on a 2000 kcal diet that would be ~400 kcal. Where did you get the 2000 kcal/day figure? I hate having incorrect numbers.

edit: sorry about the repost, don't you hate it when you read it 3x, post, then find the typo?

Kira said...

"Your brain, all by itself, burns over 2000 calories per day." Wow, really? That's more than I would have thought. I'm curious where this number comes from. Back in my dieting days I used to use a lot of those online calculators to determine your basil caloric needs (not including any movement or exercise), and they mostly ran in the 1200-1500 calorie range. Not that I trust those, of course, but if this number is true, everyone following the recommended daily guidelines of 2,000 cals would be starving, not to mention those dieting below that level. Scary!

Great post once again!

RioIriri said...

I got the figure from using the 1.5 calories/minute here, and multiplying it by the number of minutes in a day:

Maybe they're talking about calories used by your brain when you're working on a problem? To me, a crossword puzzle is not that hard, and my brain is going about a million miles an hour at any given time, so I suppose it would be highly variable.

Karen said...

ah, I see. It says that *just to survive* you need .1cal/min, but doing something like a crossword takes 1.5cal/min. I would imagine that it is the *focused* attention that leads to the 15x output, which would mean that, most of your waking time (and REM) you're probably burning far more than .1, but less than 1.5.

Possibly, you burn less on the crossword, and I burn to the max. I have a decent vocabulary, but crosswords are so cultural that I usually fall down. Sudoku on the other hand I think is a fun little break.

RioIriri said...

I'm always cranking away at something in my head--I watch very little tv (no broadcast or cable; just DVDs), because it just doesn't keep my attention. I read voraciously--I drag up stacks of 20 or more books to the library checkout, and return them all in a week or so, in addition to working through the vast library my husband and I put together when we moved in together (we had the same tastes, but dovetailed what items we had, just like in our music collection--it was very convenient). When I'm not reading, I'm writing, either on a computer or in a notebook, tutoring, or playing strategy games with friends and family.

And then, there's the typical fibro sleep disorder, where our brainwaves are stuck in high gear while we're supposed to be in deep sleep (one of the biggest problems we have)--I have the most vivid, insane, and crazy dreams, every single night.

Maybe I burn more per minute than most people?

Of course, to me, that's a validation of using your brain as much as possible (and, honestly, physical exercise bores me almost literally to tears).

Also, those who have said it's a percentage of your calorie intake--that would indicate to me that trying to live on very low calorie intakes is NOT good for your cognition.

Karen said...

I firmly agree that lowering caloric intake is back system-wide. Things like hunger, thirst and fight-or-flight are called survival mechanisms for a reason. So far as I can tell disordered eating is best defined as regularly and compulsively ignoring your bodies hunger signals.

There are probably as many people who see exercising their brain as a chore as those who see exercising their body as a chore. Perhaps, if more of both could be encouraged, we would be much closer to ending the obesity epidemic. Between proving that fat people can be just as healthy when they exercise (regardless of size) and people making a concerted effort to find out how things (like diets, WLS, and shame) actually affect people, I think great strides could be made.

Anonymous said...

Awesome post! I can't wait for the one about the Psychological issues. You are right on!

Mercurior said...

this is linked to the very topic
yes it is about veganism, but it shows nutrition is essential for children

All the nutrients that the body needs other than vitamin B-12 can be obtained from vegetable sources if extreme care is taken . However, the availability of some of them to the body is often adversely affected by the special characteristics of a strictly vegetarian diet (19) . Nutrients so affected include: energy, iron, calcium, zinc, copper, manganese, selenium, riboflavin and the fat soluble vitamins, particularly vitamin D. The best sources of these are meats, poultry and seafood, which are not eaten. But not only does the vegan diet consist of foods which are poorer sources of these nutrients, it necessarily contains high levels of fibre, phytic acid and oxalate, all of which are known both to bind with the nutrients in such a way as to inhibit their absorption in the gut and also to deplete the body of the minerals it has. The vegetarian ends up with what is called a negative balance. It is a situation where the more he eats, the worse it gets.

This applies both to adults and to children. In the case of children, however, the situation can be far more serious. Children brought up by vegetarian parents are usually breast fed, often for long periods. Where the mother has a good nutrient-rich diet, this is normally a good thing. But the nutritional condition of the mother affects the nutrients passed in breast milk to the infant. If the mother is deficient in vitamin B-12, for example, this deficiency is passed onto the breast-fed child (20) with unfortunate consequences.

With the more extreme macrobiotic diets the situation is even worse. Serious brain damage is seen in children on macrobiotic diets where it was found that " Vitamin B-12 is sufficiently low as to have psychological consequences that also raise legitimate concerns about neurological development " (21) . Other research confirms the depth of the problem. Mental development of four- to five-year-old children on macrobiotic diets (almost devoid of animal foods and fat) with long-term growth deficits, was studied. In addition food consumption and behavioural style of the children, and family and parent characteristics were assessed. Children had only seventy percent of the energy and forty percent of the calcium intake of that reported for children on conventional diets. Thirty three percent of the children studied failed to finish IQ tests due to an inability to concentrate (22) .

Infants and growing children have relatively small stomachs but large requirements for energy and the proteins and other materials with which to grow. As they can only eat small meals, they, most of all, need a diet high in energy and rich in nutrients – needs that simply cannot be met from a vegetable-based diet. When weaned, children of vegetarian parents receive a diet where their small stomachs are filled with relatively nutrient-poor foods. This can lead to grave nutritional disorders such as suppressed growth and nutritional dwarfing (23) , as well as diseases such as kwashiorkor, a protein-calorie deficiency disease usually seen only in severely malnourished African children (24) , vitamin D deficiency rickets (25) , severe iron deficiency anaemia (26) and learning difficulties (27) .

Under-nutrition in infancy has also been shown to inhibit brain growth and to have a dramatically adverse effect on intellectual development (31) . This last is a disaster as, not only is it irreversible in those children, studies have shown that their eventual offspring also suffer lower intelligence quotients.

Mercurior said...

warning pictures may not be suitable for everyone

Severe nutritional disorders, including kwashiorkor, marasmus, and rickets, were seen in four children and were due to parental food faddism, which should perhaps be regarded as a form of child abuse. All disorders were corrected with more normal diets and vitamin supplements. In view of the potentially serious consequences of restricted diets being fed to children, families at risk should be identified and acceptable nutritional advice given. When children are found to be suffering from undernutrition due to parental food faddism a court order will normally be a necessary step in providing adequate treatment and supervision

this was known in 1979. nearly 30 years ago.. and yet now its surgery that does a worse thing

Anonymous said...

One has to weigh the risks involved. As a parent, does one want a teen with a BMI over 40 entering adulthood, where the odds of losing the weight become harder? Or do they opt for WLS to help their children lose weight and avoid the potential harmful effects of being morbidly obese; physical, emotional and social?

Andee said...

Oboe, is what you're asking, "Is it worth it to get my kid an invitation to the prom and 'friends' who otherwise would shun them, even if they have to spend their 20s and beyond with beriberi, osteoporosis, rickets, dumping syndrome etc?" Believe me, the health risks of being fat pale in comparison to the health risks of having a lap band done so young. If you're concerned about the kid's health, first you rule out all possible medical causes for weight gain (and there can be many), and then you get them the best quality food you can afford, the safest possible space to be active that you can afford (both in terms of actual danger and in terms of feeling free to move about without being harassed), and otherwise LEAVE THEM ALONE.

Besides, losing weight when you're young is no guarantee it will stay off over time. In fact, it usually doesn't. Even with lap-band, the effects are usually only temporary, although they might last slightly longer than for those on conventional diets. Then you have to think of the possibility of not only being an adult with BMI > 40, but having all the aforenamed nutritional deficiencies and other physical issues on top of that. Plenty of fat adults (yes, even those with BMI well over 40) function just fine and their health is no worse than anyone else's. But throw in all those other WLS-associated comorbidities, and what you have is a huge, huge, huge crapshoot that could very well screw up someone badly who otherwise would not have nearly as much trouble.

Andee (Meowser)

Mercurior said...

ok oboe, would you like to have been mutilated when you were a child. Taken in, cut open, banded or part of your stomach removed.

but NOT by your choice, that is child abuse. People are all sizes, all shapes, i am supremely healthy which scared the doctors. they couldnt beleive it so had to do it 3 times to check to see if the machines werent wrong.

Oboe, in your scenario, it is worth dying to be thin than to live and be fat. Isnt that a SICK way to live?

Anonymous said...

Yes. I would rather have my child go through the risks of WLS than be morbidly obese. Also I think babies are getting too fat. When are the drug companies going to come up with diet pills for babies? Or some powder that I can mix in with their Diet Coke that will help burn fat.

Mercurior said...

But oboe, i know this wont change your mind, But diets dont work, as can be seen on well everyone.

so if you starve a child, its ok because its thin. if you dont feed a child thats ok because its thin So those parents who make thier kids starve to death they are good parents????. its ok to mutilate a child to be thin. But obviously you havent read the problems that can occur which are far worse than any so called obesity problems.

Anonymous said...

mecurior. I don't have a child. I was just posting some thoughts. Of course, I'd never have a child put under the knife to lose weight. But i will do my very best to instill healthy eating habits and a healthy body image from day one, as I'm sure many of you have done and continue to do.

Mercurior said...

oboe, i never stated that you in fact had a child, i just stated since your beleif in surgery, that starves children is a good thing.

"I would rather have my child go through the risks of WLS than be morbidly obese" see you have contradicted yourself, what is the difference between starving someone by neglect and starving them by surgical means.

NONE it is the same and it is child abuse.

But what if that child somehow gains weight, no matter what you do they gain weight, whether its a medical condition, or just genetics. would you love them less, are only thin people worthy of your love and respect.

Anonymous said...

When did eating healthier become synonymous with starvation? Cutting calories means that, yes, you will experience some hunger pangs! Guess what? If you're body is used to getting 3000 calories a day and you cut back to 2000, you're going to feel hungry. but the body adapts. You FA enablers confound me. Believe, short of surgery, I will do everything to prevent my kids from becoming morbidly obese. That doesn't mean I'll go crazy if they're just a little chubby. But if your child has a BMI of 40 or over, then you need to be investigated for child abuse.

Mercurior said...

WLS is Starvation. once again you have contradicted yourself in your prior comment. and Did i say anything about healthy eating. NO. healthy eating is a good thing, but what that has to do with being fat. unless you say we are all fat because we eat unhealthily.

And you mistake the idea that a growing child, their bmi is the same as an adults. IT isnt, children need the higher energy foods to help them grow. so you may be chubby as a kid, but that doesnt mean you will have a high bmi later on. (and in the lat 90's the definition of obese changed. millions of people went to bed fine, but woke up obese)

Anonymous said...

WLS is starvation. I constantly hear the same old argument. You and I must have different definitions of starvation. WLS provides something that most overweight people do not have. Portion Control!!
A child in a third world country with a bloated stomach is starving. A teenager with a BMI over 40 whose had WLS and is experiencing hunger pangs isn't starving. He/she is getting their act together. Kudos to them!

RioIriri said...

Oboe, it's apparent that you haven't educated yourself about this subject. Please read the Gina Kolata article here, and until you demonstrate some knowledge on the subject, you are no longer welcome in my blog. Further trolling comments will be deleted.

Anonymous said...
This comment has been removed by a blog administrator.
thoughtracer said...

Oboe: I am so sick of all the fattie fat babies. Good god. How can anybody let their baby get so fat? I thought it was just great when Anna Nicole Smith was accused of not feeding her baby enough because she wanted it to be sexy. I am so looking forward to the day when in-utero WLS is an option! I mean, wouldn't that just be great? Do you know of any low-cal formula I could give to babies? Because if I get pregnant, I wouldn't want to breast feed, because I am going to be too busy losing weight and managing the BMI of my tiny infant! That's what responsible parenting is all about, after all! :D
Maniacally yours,

RioIriri said...

Wow, Oboe used the c-word because I requested he have a basic level of knowledge before leaving further comments on my blog.

Misogyny is fun!

AnnieMcPhee said...

You were more patient than I would have been.

"Yes. I would rather have my child go through the risks of WLS than be morbidly obese."

That just about says it all, don't you think?

"Also I think babies are getting too fat. When are the drug companies going to come up with diet pills for babies? Or some powder that I can mix in with their Diet Coke that will help burn fat."

LOL - yes, diet pills have worked SO WELL for adults - let's see, the amphetamines did the trick - sure you were climbing the walls and damaging your brain, but you lost weight! And the Alli - alls ya gotta do is leak foul orange oil out your butt and pores, diet extensively, and lose 3 pounds more per year than those who don't take the pill. Haha.

And, er, why would anyone be feeding a baby diet coke? Babies...too fat lol.

Mercurior said...

as i have said, being fat is the only valid discrimination, it does affect women slightly more than men, but as a fat man myself, it would affect me too.

is it misogny, no its misanthropy, the hatred of all not with a certain look. or fatism, fat crosses every culture every colour, and thats the point.

its so easy to blame fat on moral failings, to say that its gods punishment to make you die .. But as you know its untrue. As that commentor said, you are this then this WILL happen. as if being thin is a purer experience, and that because we obviously must be defective because who would choose to be fat, so QED they must be enablers must be sick, must be abusive.

i have thick skin, (pun intended), i have heard all this before so many times, that once more isnt goint to make me upset.

Anonymous said...

Sad little trolls, no life of their own.