Monday, February 25, 2008

Kids & WLS, Part Two: Psychological considerations

Do kids really want bariatric surgery? A friend asked me this, and I was able to point to Meowser's comment on a previous blog post:
*I* probably would have wanted the surgery from the time I was 12 or 13 or 14 -- it will get me to stop eating so much! I'll be skinny! I'll be pretty! I'll have a boyfriend! A BOYFRIEND WHO LOVES ME!!! Where do I sign up? And I wasn't even "obese" then, just chubbier than what was considered "pretty," and I wanted "love" SO BAD, and I was utterly convinced that it was my fat ass standing in the way (noooo, it had nothing to do with the fact that no boy I had ever met then was capable of loving me the way I dreamed of, fat or thin).

Some of them DO want it, and who can blame them? Fat kids are ostracized by just about everyone around them--peers, families, teachers, even other fat kids (who'd rather be seen as trying really hard not to be a fat kid than teaming up with other fat kids for solidarity). Every waking moment is filled with reminders that they are less than human because they are fat. They are bombarded with media telling them that they are GOING to die ANY MINUTE NOW unless they become thin. With the cruelty they face every day, and the hysterical messages they don't have the experience to filter out, who can blame them for wanting a procedure that promises to give them the one quality that keeps them from participating normally in society, when that procedure's slick marketers hype the positives and downplay the very real and dangerous risks?

Before, I discussed the physical health concerns unique to growing bodies; now I am going to discuss the possible psychological problems that would be especially influential on youthful minds.

For a young person, WLS prevents the development of a healthy and normal relationship with food and eating. If a child's eating patterns are disordered in the first place, such as binge eating disorder, then inducing the other end of the spectrum in disordered eating does not really address the core problem; it simply trades one form of disordered eating for another. To survive after WLS, the patient's life MUST center around food--planning meals at certain times, figuring out what foods don't make the patient ill, and making sure to get enough nourishment to maintain basic function. This is not a responsibility a child should be dealing with, especially when mistakes can be harmful or deadly. Disordered eating patterns should not be dealt with by physically changing the body to keep a child from binge eating; such problems should be dealt with by mental health professionals with experience in helping young people overcome eating disorders.

The pervasive idea that worth is tied to physical attractiveness is reinforced by WLS. The "Fantasy of Being Thin", in which the fat person imagines becoming thin will make them more valued by society, and will result in having friends, boy/girlfriends, and stopping bullies from torturing them. What happens when being thin does not change their social stigmas, though? What happens when a young person comes to believe that they only need to change the way they look, and they don't mature emotionally or mentally because they are tied up in their quest for external beauty? Furthermore, what happens when, after they lose the weight, and have their dreams come true, they regain it, bringing back the "old self" they never learned to accept? It is completely unfair to ask young people to undergo the risks of WLS just to receive social acceptance; it would be far more fair to end tolerance toward bullies and shaming.

Kids are so frightened of being fat that they would rather lose a limb (there's a study...I'll find it and link to it) or die than be fat. Rather than caving in to this phobia by carting them off to the surgeon to have their guts rearranged, it seems more reasonable to have a phobia treated as a mental health issue. Instead, fatphobia is encouraged and legitimized by the rabid "health" officials who are selling a disease and procedure--the same people who give us ridiculous "good food/bad food" video games to install in school computers, and show us headless fat bodies on television, along with video footage of fast food on trays.

WLS is an expensive, and, in the long run, ineffective way to protect children from the growing fear of being fat. Fat happens. WLS patients regain the weight. People have genetic predispositions, and many medical conditions and medications can cause weight gain. Rather than responding to the potential of becoming fat with terror and shame, children would be better off if they were taught coping skills, tolerance, and self-worth based on things not related to physical appearance.

Finally, I want to say this loud and clear: WLS for kids is child abuse.

For already abusive or controlling parents, WLS can give an even greater degree of control. Perhaps it is too horrible for most people to even consider, but knowing what I do, I can envision abusive parents withholding food from their de-stomached children, making them eat food that causes them to vomit, and forcing them to eat more than they are safely able to eat. Of course, that is the extreme example, but there are less direct forms of abuse that I can imagine arising from approving WLS for kids. For example, what if the parents want it done, but the child says no? Who wins? It can be used as a threat to punish kids for not losing weight, or for not getting good grades, or, well, use your imagination. In just as bad a scenario, a child could be opposed to the idea, but too fearful of the parents to say no. Also, if the kid DOES want WLS, the promise of bariatric surgery (and thin fantasy fulfillment) can be used to torment and manipulate, even when the parent has no intention of allowing it to happen.

WLS is a last resort for people who have no other options left, and who truly feel they are unable to otherwise have any quality of life. As long as any underlying health problems are being concurrently treated, and the person is able to make the decision with all of the facts, it really is a matter of personal choice. What we're seeing, however, is WLS foisted onto young people as a solution to their social problems and psychological issues--young people who can't even consent to a tattoo, yet are expected to undergo a major irreversible rerouting of their internal organs. I do not believe that this is a wise thing to do.


Mercurior said...

Being fat is the only truly accepted discrimination, you cant discriminate for colour, race, religion, sexual practices. So whats left being fat which crosses every layer of society.

I firmly beleive these people who push thin is best, thin is great, fat is morally suspect. are the ones with the problem.

The push to make children into, what is essentially toys. They must wear this, they must look like this. Is just creating a whole generation of sick people.

Whatever happened to being happy with yourself. I would rather be fat and happy than thin and miserable. I would rather live till i am 60 or 40 and enjoy life, than sit and watch every morsel of food for a possible 1 year longer life span.

WLS is a relatively new surgery, whats going to happen in 40 years, when these children want children (if they do). Will they be able too?. Theres just so many unknowns.

But you are right, it is child abuse. Whats the difference between starving a child (not feeding it due to neglect), and not feeding it due to WLS. ABSOLUTELY NONE. Abuse is abuse.

Whether its done for "health" or "looks", or for any other reason.

vesta44 said...

I wish to heaven that I had the time and money to print out the list of complications/side effects from OSSG-gone_wrong and hand them out to every parent who is even thinking about WLS for their child. If they read that list, and talked to people from OSSG instead of the cheerleaders still in the honeymoon phase, they just might have second thoughts about putting their child through that (but maybe not, they might think "that couldn't happen to my child"). I really think WLS will not help these kids, not in the long run. In the long run, it's going to ruin their lives and possibly, probably quite likely, shorten them considerably. That's what those parents need to know.

Anonymous said...

I like where you said they should go after the bullies and shamers. Like that's ever going to happen. Don't you know, bullies are the perpetual victims. "They do it cause they have a bad hooomeeeliifffee" or "They're mean cause they're hurrrttinnngg inside"

Why should their pain even be validated, while they sadistically run around causing pain onto others.

M. said...

I had a friend who had gastric bypass when she was a senior in high school. And for a while she was as thin as everyone thought she "should" be.

Then she learned how to eat around the surgery. Basically with constant high calorie grazing, that I'm sure was her body's attempt to get enough calories to survive. She gained most of it back in about five or six years.

Melody said...

Well I’ve had WLS and consider myself a success, I lost the weight I wanted to lose and have maintained a healthy weight since then (gastric bypass surgery was in March 2005). That being said there is no way I’d allow my child to have WLS. You’ve got to really have your head on straight to succeed with this, you’ve got to watch what you eat FOR THE REST OF YOUR LIFE, you’ve got to take vitamin/supplements FOR THE REST OF YOUR LIFE, you’ve got to follow up with your doctor to ensure that your bloodwork remains normal FOR THE REST OF YOUR LIFE. It’s a commitment that at 38 I have no problem with. WLS has been wonderful for me and has changed my life for the better 100% but I’m also at a point in my life that I’m mature enough to understand that it takes work, that there are risks and that it is most definitely not easy. I would never recommend this surgery to anyone as my experience may not be their experience.

I do think that childhood obesity rates are horrible and that as a country our children are in a crisis. However, I don’t think WLS for teens is the answer.

Also to reply to a previous commenter WLS is not a relatively new surgery, it was first performed in the late 60s. I’m not a rah-rah WLS cheerleader but just wanted to point that fact out. It just seems like it’s a recent surgery technique since the media attention to WLS has increased so much in recent years, before that people really didn’t know much about it.