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protects the heart, brain, joints, and other organs and body systems throughout life. Other benefits are more difficult to measure statistically, but they are just as instrumental to a young person's health and well-being. During the teenage years, obese individuals may experience bullying, which the current digital environment only amplifies. Obese adolescents and teens may struggle with self-esteem. They're more likely to sleep poorly and to lack focus and sufficient energy for activ- ities of daily living. Body image, energy levels, personality and ability to focus and perform schoolwork or function within the workplace are all affected by obesity. " There a re ma ny medica l [issues] caused by being overweight," Dr. Atwa says. " Yet you don't go to the hospita l because you're obese. We treat some of the medical problems, but it's essential to treat the cause of all these medical issues." Resolving the underlying disease — obe- sity — improves all these areas. Ultimately, e a rl y b a r i a t r i c s u r ge r y i n c r e a s e s qua lity-of-life scores for appropriate adolescents and teens. TIMING THE PROCEDURE Cur rent ly, t he A mer ica n Academy of Ped i at r ic s recom mend s a dole scent ba riatric surger y for those w ith a BMI t hat is 120% of t he 95t h percenti le for their a ge a nd weight . This recommen- dat ion ca me on t he t a i ls of resea rch i nclud i n g one s t udy t h at fou nd t h at patients who undergo ba riatric surger y ma inta in a n avera ge 29% reduction in BMI at 12 yea rs a f ter surger y. I nd ic at ion s for ba r i at r ic s u r ger y a mong adolescents a nd teens include: + BMI of 40 or g reater + B M I o f 3 5 w i t h a w e i g h t - r e - lated comorbidit y Despite positive results a nd millions of teens liv ing w it h obesit y, surgeons per for m fewer t h a n 2 ,0 0 0 ba r iat r ic procedures on adolescents each yea r. This puts chi ldren at a distinct disad- va nta ge, a s ea rlier inter vention leads to improved outcomes. "[Ch i ld ren a re] rea l ly f ra g i le ea rly on [when] t he y 'r e de ve lopi n g t hei r psycholog y," Dr. At wa says. " You wa nt to catch [a nd treat obesit y] before [chil- dren] go into high school or col lege, [to help] when t hey 're sti l l developing." One rea son t here a re so few surger- ies is t he dea r t h of ava i lable su rger y centers that of fer adolescent ba riatric su rger y. St . Cha rles Hospit a l i n Por t Je f f e r s o n , w h e r e D r. A t w a s e r v e s a s D i r e c t o r, C h i e f o f S u r g e r y a n d Director of Robotic Surger y, is one of the few hospita ls in New York of fering t he procedu re. T here, Dr. At wa a nd L on g I s l a nd L a pa r o s c opic D o c t or s of fer ba r iatr ic surger y for patients a s Nicholas A., age 19, lost 115 pounds following a gastric sleeve procedure. "Everything is better," he says. "I have more energy, less knee pain and I can do more." BEFORE AFTER Gastric sleeve procedure 1 4❱❱❱❱❱ S U R G I C A L S O L U T I O N S