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young a s 14. (The met hod of choice is robotic sleeve ga strectomy.) By t h is age, most children's bones a nd g row th plates have completed development . A lso, the patient is mature enough to follow post-surgica l instruction to help ensure success. W hile surger y is available starting at age 14, eva luation a nd education of ten beg in si x months prior to turning 14. Because a successful procedure depends on a st able suppor t s yst em , t he si x- month prep period enables providers to see the child's support system in action. Providers a lso have the oppor tunity to educate patients on lifest yle cha nges ba riatric surger y dema nds a nd a llow for specia lty eva luation. At St. Cha rles Hospita l, a multidisciplina r y tea m fol- lows patients throughout the process. Prior to surgery, pediatricians, pulmon- ologists, cardiologists and psychologists each sig n off on the hea lth a nd f itness of a g iven adolescent ca ndidate. SURGICALLY INDUCED SUCCESS With a 45-minute procedure, young, obese individuals take a significant step forward, potentially eliminating many common health issues associated with obesity. Previously, researchers thought this weight loss was due to the smaller stomach left behind after bariatric sur- gery. More recent research has indicated a deeper source of weight loss. "The reason dieting is .05% successful is because when you're dieting, your brain says you're hungry," Dr. Atwa says. As a result, many fail when relying on diet alone. "[Compare that] to bariatric sur- gery, where there is a significant decrease in hunger." Though the precise mechanism remains a mystery, successful surgery redirects or otherwise interferes with the neurohor- monal pathway that decreases the amount of ghrelin hormone and increases the GLP1 (Glucagon-like peptide 1) and PYY (peptide YY) hormones. This hormonal reconfiguration leads to appetite control and weight loss. Thoug h t he mecha nism by which adolescent bariatric surgery succeeds is not yet completely understood, the results are consistently positive. To date, the procedure has a 0% mortality rate among adolescents. Comorbidities are typically resolved or prevented in the first place. Teens have renewed self-conf idence and energy. Such results have helped push many pediatricians toward acceptance of the procedure. For obese children, the same is often true. When family members or friends undergo ba riatric surger y to positive results, obese adolescents see what changes are possible. Because of the consistently good outcomes, the number of adolescent procedures Dr. Atwa performs each year is increasing. This trend is likely to continue. "When young patients come to us, they want it done yesterday," Dr. Atwa says. "They can't wait to get the operation." When asked how their lives have changed since surgery, the answer is the same. "They say everything is better, that they should have done it a long time ago." As the medica l community gains a better understanding of the need and benefit of adolescent bariatric surgery, pediatricians will become more likely to refer patients for the procedure. This is the starting point of a future in which more adolescents and teens avoid a life of obesity and its inherent complications. ■ V i s i t J o u r n e y T oT h e N e wYo u . c o m t o l e a r n m o r e a b o u t L o n g I s l a n d Laparoscopic Doctors. The Next Steps in Obesity Care N ATION W IDE, A DOLE SCENT BA RIATRIC surgery yields 80%–85% success rates, notes Hesham Atwa, MD, FACS, FASMBS. Within his practice, however, 90% of patients find success. Though sleeve gastrectomy provides excellent results in the obese adolescent population, Dr. Atwa admits that the ideal solution is not intervention. Rather, it is obesity prevention, which may exist in the near future. Such preventive measures are likely to result from the following two developments: + Determining and eliminating the toxin that is responsible for the genetic disposition for obesity. + Genetic testing to identify those children at risk for adolescent obesity and taking steps to monitor and treat them in a timely manner. Additionally, other therapies hold promise of providing alternatives to surgical intervention. Currently, researchers are working to determine the efficacy of diabetes medication to aid in weight loss. Should this prove fruitful, surgical intervention may become unnecessary. Until then, bariatric surgery remains the greatest therapeutic intervention available to obese adolescents. To ensure maximum benefit, ongoing support is vital. Dr. Atwa finds that those who enjoy the greatest long-term weight loss take advantage of a support group with fellow surgery patients and have a strong support system at home. M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 1 5