Surgery, Drugs, or Counseling for Heavy Kids?

Adults never seem to know what to do about fat kids. Since the idea of doing nothing doesn’t seem to be popular, and neither does trying to change the way our society views and talks about weight, more extreme options are fair game. This includes surgery or, now, drugs.

So, I was interested to see a report from a recent study that suggests another option: comprehensive coaching for obese children. It got me thinking about the various options, and how I might have reacted to them as an overweight teen.

Weight loss surgery

I’m not sure when weight-loss surgery became available to teens or kids, but if I were a teen now, I would undoubtedly qualify for it. Based on my height and weight at age 17, I was in the 99.5th BMI percentile, with a BMI of 43.5. And for surgery, you only need a BMI of 40 to qualify (or 35 if there are “complications of obesity”).

A few things about this concern me.

One is that the American Academy of Pediatrics (AAP) doesn’t suggest any age limits for bariatric surgery. The idea of this kind of life-altering surgery for a kid whose age is in the single digits (or even low double digits) seems completely wrong to me because the kid would have no real concept of what they were signing up for.

That brings me to my second concern. Bariatric surgery is “not recommended for those who can’t follow all the post-operative recommendations, including all the lifestyle and eating changes that are mandatory after surgery.”

I can tell you for a fact that even at 17 – let alone any younger, when I would have still qualified for the surgery – I wouldn’t have truly understood what this would mean for the rest of my life, how it would forever change how and what I ate. I’m sure I would have been eager for the weight loss, but I would have ignored the reality that a lot of people who undergo surgery don’t lose all the weight they want, and many gain a lot of the weight back.

Then there’s also the fact that getting the appropriate nutrients can be tricky after bariatric surgery. That’s a concern for anyone, but especially for kids who are going through puberty and whose bodies are changing and growing.

Given that, and the fact that young people often have a hard time understanding the lifelong impacts, I don’t think kids should be having this surgery.

Weight loss drugs

Details about weight loss drugs and their impact on teens or kids are harder to come by because the drugs are still new, and that’s part of what concerns me. We don’t fully know the long-term effects on younger people who are still developing. As with bariatric surgery, I’d worry about teens not absorbing all the nutrients they need or the possibility of not building bone mass.

But even beyond that, these types of drugs require a weekly injection that needs to be done indefinitely if you want to maintain weight loss. Again, I’m not sure a teen is really prepared to make that kind of lifelong commitment – or commit to the cost. (Note that Ozempic is not approved for those under 18, but Wegovy is approved for those 12 and older.)

Plus, I had a friend in high school who had Type 1 diabetes, and I remember how much he hated having to give himself insulin shots. It’s not a very pleasant thing to do, and he was depressed at knowing he’d have to do it forever. I might feel the same as a young person on a weight loss drug.

Finally, there’s the food factor. While on Ozempic or Wegovy or similar drugs, you’re supposed to avoid or limit quite a few things: sugary foods, including cake and ice cream, and sugary drinks; fried foods; foods high in saturated fats, such as beef, pork, or lamb; and items high in sodium (i.e., processed foods).

To me as a teen, that would have felt like another diet, and I suspect I would rebel against it. I realize that people on these weight-loss drugs generally don’t have the same food cravings they did before, so maybe I’m wrong about this point, but it’s a concern.

Counseling

Finally, the option of counseling and behavior modification.

I tried some things like this, though probably not the exact recommendation that just got released since that involves the parents and includes meeting in peer groups.

I can say that the individual therapy sessions I have didn’t help me because they made me feel like something was drastically wrong with me and I needed to be fixed. Kids today might not feel that way since we’ve made a lot of progress when it comes to the stigma around therapy – but it hasn’t gone away fully.

Still, this seems like a more sensible approach to me, at least to try. If kids can change their relationship to food and their bodies, that will benefit them their whole lives without the more drastic changes from surgery or drugs.

Unfortunately, even if this approach works, it requires a lot of time, effort, and coordination between parents and doctors and the kids, and I’m sure it’s not free, either. So, I’m not sure how feasible it will be for a lot of kids.

Removing stigma

From everything I’ve read and experienced, the best thing we could do for heavy kids – and adults – is to try to remove the stigma around being overweight and do away with diet culture.

Sadly, that doesn’t seem like a realistic option, much as I like it to be. Given that, I do like the counseling option best, but ultimately, it’s going to be up to the individuals and families.

I just hope that parents can let their kids grow up and decide, with an adult brain and body, what’s best for them, since they’re the ones who’ll have to deal with that decision for the rest of their lives.