Severely obese teens turn to surgery and new weight-loss drugs despite controversy

According to his mother, John Simon III was a hungry baby, a “stocky” toddler and a chubby boy. But by the time he was 14, his weight had skyrocketed to 430 pounds, a condition that threatened his life.

Nine months after weight loss surgery to remove a portion of his stomach, John has lost about 150 pounds, feeling better and more hopeful for the future.

“It was like a whole new start,” said John, who will start high school in California this fall.

In Minnesota, Edward Kent was diagnosed with fatty liver disease. The 6-foot-tall, 300-pound high school sophomore began using the obesity drug Wegobee in January, just a month after federal regulators approved it for children ages 12 and older. and lost 40 pounds.

“This is a very big deal and will affect him for the rest of his life,” said his mother, gynecologist Dr. Barbara Van Eckhout. “This is about his health.”

John and Edward are among a small and growing group of teens who are turning to treatments such as body-altering surgery and new drugs that rewire their metabolism to significantly reduce their weight. . Critics have called for caution in intervening too early, but children and their parents have spent years on ineffective diet and exercise programs, and this aggressive, and often costly It argues that such measures are necessary options.

“John tried his best,” said Karen Tillman, 46, a mother and accountant. “It wasn’t because he couldn’t try. It just got harder and harder.”

80% of overweight adolescents carry it into adulthood, which can have dire consequences for their health and longevity. Obesity was first classified as a complex chronic disease by the American Medical Association a decade ago, but meaningful treatments have fallen far behind, said Aaron Kelly, co-director of the University of Minnesota Pediatric Obesity Medical Center.

“This is a biologically caused disease. It’s not a behavioral disease,” Kelly said. “You need to work on it sooner. Don’t wait until later in life because it’s too late.”

The American Academy of Pediatrics issued guidelines in January asking children by age 12 to consider obesity drugs, and by age 13 to consider surgery. This recommendation was immediately controversial.

The advocacy group Mental Health America called the symptoms “dangerous” and “disappointing,” saying such diets increase eating disorders and perpetuate harmful weight stigma. food Or video games, or accuse parents of “child abuse.”

Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital, warned that “justifiable excitement” about new weight-loss drugs shouldn’t overshadow other options.

“Diet and exercise must remain at the forefront of obesity prevention and treatment, especially for children,” he wrote in JAMA.

But health professionals working with severely obese children say research shows that diet and exercise alone aren’t enough. Dr. Janie Pratt, the Stanford University surgeon who operated on John Simon, says more than 240 illnesses, including liver disease, diabetes and inflammation, are associated with excess weight and show early signs.

“By the time it got to me, it had already affected major organs,” Pratt said. “You are dealing with a train going over a cliff.”

Since elementary school, John suffered from joint pain, shortness of breath, and severe sleep apnea, and needed coffee to wake him up at age 12. He developed anxiety after being bullied daily at school and was hospitalized for two months with post-traumatic stress disorder in sixth grade.

“They name me, they beat me, they shove me. All of the above,” John said. “It was a lot of hardships I had to go through.”

He tried dieting and exercising and lost up to 40 pounds. But intense food cravings always meant weight gain back, and even more. John’s BMI was 75 when he met Dr. Callum Low, pediatric resident at the Public Health Clinic at Children’s Hospital of Los Angeles. He was way off the charts that measure BMI. , which is considered a flawed tool, but is widely used by physicians for obesity screening.

With a shy smile and a soft voice, John called for help. He said he wanted to go on a “journey to health,” Rowe recalls.

“I thought it was so deep for a 13-year-old. He’s an old soul to have such insight into what he can do to change his situation.” Lowe The doctor said he referred John to the Stanford Medicine Children’s Health weight loss program.

That meant going 550 miles north to Palo Alto, but Karen Tillman said she was ready for anything.

“His weight was increasing by the minute,” she said.

Pratt said applications to Stanford’s surgery program have doubled since the release of the AAP guidelines. Here in one of the busiest facilities in the United States, he performs over 50 of the 2,000 pediatric weight loss surgeries recorded each year.

John was lucky. He is less than 1% of children eligible for metabolic surgery. Doctors are reluctant to make referrals, and families either don’t know it’s an option or it’s too expensive, experts say. Fees can reach upwards of $20,000 and in some cases reach $100,000.

John’s surgery was covered by California Medical’s Medicaid program, which paid for 47 surgeries on children ages 11 to 17 last year, according to state medical records. Across the United States, Medicaid coverage for children’s weight loss surgery varies greatly by state.

Studies show that, on average, children who undergo weight loss surgery lose about a quarter to a third of their body weight. But about 25% of the children have lost weight and need further treatment, Pratt said.

A clinical trial using Wegovy showed adolescent weight loss of approximately 16% over approximately 16 months. A study found that people taking obesity drugs, who are seeing a surge in demand across the country, including at Stanford University, regain weight when they stop taking them. Some people taking this drug may experience serious side effects such as gallstones and inflammation of the pancreas.

Edward Kent responded well to the obesity drug, his mother said, “like an electric switch” that turned off his voracious appetite. Recent tests showed that Edward’s liver function had returned to normal.

John Simon lost about 35% of his weight within a year. Both liver function and insulin resistance improved, Pratt said. His arthritis is healing. He sleeps better and is more mobile.

John’s struggle goes beyond overcoming appetite and improving his health. Attacks by bullies became so severe in his junior high school that teachers were ordered to walk with him during class.

John’s pastor, Charles Griffin III of the Dayspring Church of Christ, said: “He will come back with some injuries. Our prayers are that he will be stronger when he recovers from this situation.” rice field.

John graduated from middle school earlier this month, but authorities declined to comment on steps taken to combat bullying. Next year he will attend a charter high school that his mother hopes will be a smaller, more caring school.

John, now 15, is focused on the future. He has learned to make healthy meals, such as a recent dinner of sautéed shrimp and chard. He trains at a local gym, counts 18,000 steps a day on a pedometer, and wants to study hard to land his dream job as an automotive engineer.

“I just want to live a happy and healthy life,” he said. “No pain, just no weight.”

___

The Associated Press’ Health Sciences Division is supported by the Howard Hughes Medical Institute’s Science and Educational Media Group. AP is solely responsible for all content.