More Kids Get Weight-Loss Surgery to Treat Obesity

Bariatric surgery was performed on 506 children at the more than 40 U.S. children’s hospitals that use a billing database called the Pediatric Health Information System, a fivefold increase from 2012. Obesity rates among children continued a decadeslong climb during that time. One-fifth of U.S. children were obese before the pandemic, according to the Centers for Disease Control and Prevention, and research shows weight gain among children surged during the pandemic. 

Rephoel Grossman tried countless diets, appointments with dietitians and even weight-loss drugs before his weight peaked at some 435 pounds in October 2021, when he was 15 years old. Rephoel, who is 5 feet 10 inches tall, had sleep apnea, hypertension and high cholesterol. He became winded too quickly to play sports. He was too heavy to ride roller coasters. He didn’t like to fly because it was so difficult to fit into airplane seats. 

Last June he underwent bariatric surgery at Nemours Children’s Hospital, Delaware, in Wilmington. His surgeon, Dr. Kirk Reichard, performed a sleeve gastrectomy, removing part of Rephoel’s stomach to restrict food intake and reduce appetite. 

“I didn’t know the meaning of full before,” Rephoel said. “I know what full is now.” 

People with severe obesity who received bariatric surgery as teenagers were healthier in the long run than people who waited to get it as adults, according to research led by Dr. Thomas Inge, surgeon-in-chief at Ann and Robert H. Lurie Children’s Hospital of Chicago. 

His research tracking the health of 250 people over 10 years who underwent bariatric surgery in their teens helped inform the American Academy of Pediatrics’ recommendation in January that treatment for obesity start early and aggressively. Bariatric surgery and weight-loss drugs can benefit children as young as 13 and 12, respectively, the guidelines said, because losing weight is so difficult and the risk of lasting health harm is higher the longer children have severe obesity. 

“There’s no evidence that there’s any benefit to watchful waiting,” said Dr. Sarah Hampl, a lead author of the AAP guidelines and a pediatrician at Children’s Mercy Kansas City in Kansas City, Mo. 

Weight loss isn’t simply a matter of will power, researchers said. Decades of research have shown that people who lose large amounts of weight through diet and exercise tend to gain it back. There is a scientific reason for that, doctors said: The body has a weight range that it works to stay within, and it will fight to keep weight on. 

Bariatric surgery, in ways scientists are still exploring, changes that range, altering hormonal signals between the gut and brain that communicate hunger and fullness. That is why bariatric surgery can help when diet and exercise routines fail, weight-loss doctors said. 

Amy Scheiner, a 32-year-old writer in Robbinsville, N.J., was 17 when a surgeon inserted a band around the upper part of her stomach to limit food intake. 

She didn’t realize she had binge-eating disorder, with which she was later diagnosed, and the surgery exacerbated her eating issues, she said. She has gained back nearly all the weight she lost after surgery. 

She said others could also obsess even more about food and weight after such procedures. “For children who are still growing whose brains haven’t fully developed, who haven’t hit puberty yet, who don’t know why they’re eating, why their body is this size, to have such a permanent change in their biology is awful,” she said. 

Nemours Children’s Hospital, where Rephoel underwent surgery, said it hasn’t offered lap-band surgery for years. The procedure has fallen out of favor with surgeons and is only approved for patients 18 and older. 

The hospital said it screens patients for eating disorders before considering them for bariatric surgery. Patients diagnosed with a disorder are referred to therapy before getting bariatric surgery. 

The hospital requires patients to show that they can maintain lifestyle changes before the procedure. Rephoel lost about 70 pounds before the surgery. Afterward, he said he could no longer tolerate large amounts of oily, fatty foods. He didn’t have as many cravings. He lost close to a further 150 pounds. 

Some acquaintances and friends have accused him of taking the easy way out. “They think you go in, go under anesthesia, come out and you’re skinny,” he said. “I still have hunger. I still have cravings. The surgery just makes it a little easier to deal with.”

His sleep apnea has abated and he is sleeping through the night. His blood pressure is normal. He has started playing basketball. It is tough competing against classmates who have been practicing their whole lives, he said. More activities are on his agenda for this summer. 

“I’m planning to go on a roller coaster for the first time since I was 8 years old,” he said.

Write to Sarah Toy at [email protected]

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