Weight Loss Surgery for Children and Teenagers in Türkiye

In a world where obesity in children and teenagers is on the rise, the question arises whether invasive methods like weight loss surgery are an appropriate solution. This article delves into the pros and cons of this controversial topic.

Causes of Obesity 

Before addressing whether weight loss surgery is viable, it’s vital to understand the causes of obesity. Genetics, lifestyle, diet, and lack of physical activity are among the factors contributing to this epidemic. Often, it’s a combination of these reasons leading to significant overweight issues.

Why Consider Weight Loss Surgery? 

The primary arguments in favor of weight loss surgery are:

• Rapid and substantial weight reduction.
• Improvement or resolution of obesity-related diseases like type-2 diabetes, hypertension, and sleep apnea.
• Boosting self-esteem and overall quality of life.

Risks and Concerns 

Despite the advantages, weight loss surgery carries inherent risks. These include surgical complications, nutrient deficiencies, and psychological effects. It’s imperative to carefully weigh the pros and cons.

Alternative Treatment Methods 

It’s essential to stress that weight loss surgery is typically considered a last resort. Conservative approaches like dietary changes, physical activity, and psychological support should be the first line of action.

Conclusion 

Weight loss surgery for children and teenagers might be justified in specific scenarios, especially when all other methods have failed, and severe health issues persist. However, it’s crucial that such a decision is made meticulously and together with experts. Every procedure should be complemented by thorough pre- and post-operative care to ensure the best possible outcome and the well-being of the young patient.

The decision on a specific type of obesity surgery for children and teenagers depends on various factors such as the patient’s health condition, the extent of obesity, and the recommendations of the treating medical team. Here are the most common types of bariatric procedures for this age group:

Overview

Sleeve Gastrectomy:

• Procedure: In this approach, a large part of the stomach is removed, leaving a tube-like residual stomach.
• Advantages: There’s no alteration in the small intestine, affecting nutrient absorption less. The procedure is less complex than some other bariatric surgeries.
• Risks: Potential for leaks or bleeding at the surgical site. Over the long term, there can be an expansion of the remaining stomach portion.

Roux-en-Y Gastric Bypass:

• Procedure: Here, a small portion of the stomach is separated and directly connected to the small intestine.
• Advantages: Besides reducing the stomach size, the food diversion creates a malabsorption effect, leading to faster weight loss.
• Risks: As part of the intestine is bypassed, nutrient deficiencies can arise. There’s also an increased risk for dumping syndrome.

Adjustable Gastric Banding:

Procedure: An adjustable band is placed around the top part of the stomach, creating a small pouch.
Advantages: The procedure is reversible and doesn’t influence nutrient absorption.
Risks: The band can slip, leak, or lead to infections. Some patients don’t achieve the desired weight loss post this procedure.

Decision-Making

In choosing the right procedure, it’s essential to consider the individual needs and circumstances of the child or teenager. A multidisciplinary team consisting of surgeons, nutritionists, psychologists, and pediatricians should be involved in the decision-making process and post-operative care.

Sleeve gastrectomy (Gastric Sleeve) is a bariatric procedure that has become widespread among adults recently and is also considered for children and teenagers with severe obesity. However, the safety of this procedure in this age group is a crucial concern and is discussed below:

Studies and Data 

There are multiple studies evaluating the safety and efficacy of sleeve gastrectomy in teenagers. Many of these studies have shown positive outcomes, including significant weight loss and an improvement in comorbid conditions like Type 2 diabetes or hypertension. However, the number of procedures performed on children and teenagers is still limited, which means long-term data is restricted.

Surgical Risks 

Like any surgical procedure, there are inherent risks. These include infections, bleeding, scarring, or the risk of leaks at the stomach’s surgical site. However, compared to other bariatric procedures like gastric bypass, sleeve gastrectomy is technically less complex and often has a shorter recovery time.

Nutrient Deficiency 

Since sleeve gastrectomy doesn’t bypass the small intestine, the risk of nutrient deficiency is less than with procedures like the Roux-en-Y gastric bypass. Nonetheless, it’s essential to regularly monitor nutrition and nutrient intake to ensure the body receives all necessary vitamins and minerals.

Psychological Factors 

Rapid weight loss can also have psychological implications, especially in teenagers undergoing a critical phase of their identity development. Thus, psychological counseling before and after the procedure is vital.

Conclusion 

While sleeve gastrectomy appears safe and effective for many children and teenagers, it should be viewed as one of several available options. The decision for this or another procedure should be based on a thorough evaluation of the individual case, an understanding of potential risks and benefits, and a comprehensive discussion among the patient, family, and medical team.

Gastric bypass, such as the Roux-en-Y gastric bypass or mini gastric bypass, is a common bariatric surgery performed not only on adults but also on children and teenagers with severe obesity. However, the question of this procedure’s safety for younger patients is multifaceted:

Overview

1. Current Studies: Multiple clinical studies and research have demonstrated that gastric bypass can lead to significant and sustained weight loss in teenagers. Additionally, improvements or even reversals of obesity-related conditions like Type 2 diabetes or hypertension have been observed in many patients.

2. Surgical Risks: Like any surgery, gastric bypass has its risks. These include, but are not limited to, bleeding, infections, scarring, and the risk of internal leaks. There’s also a minor risk of complications related to anesthesia.

3. Nutrient Deficiency: A primary concern with gastric bypass is the potential for nutrient deficiency. Since a part of the intestine is bypassed, there can be restricted absorption of certain vitamins and minerals. This can lead to deficiency symptoms if not carefully monitored and managed. Regular blood tests and dietary supplements are often required.

4. Dumping Syndrome: Some patients post-procedure experience what’s known as dumping syndrome. This is a group of symptoms, including dizziness, sweating, and diarrhea, that can occur when food moves too swiftly from the stomach to the small intestine.

5. Psychological Aspects: Rapid weight loss and adjusting to a changed lifestyle can bring about psychological challenges. Monitoring the mental health of children and teenagers before and after the procedure and offering support when needed is vital.

Conclusion 

While gastric bypass can yield positive results for many children and teenagers, it is crucial that the procedure is performed in specialized centers with experience in pediatric bariatric surgery. Thorough pre-assessment, meticulous post-operative monitoring, and a multidisciplinary approach to care are essential to ensure the patient’s safety and well-being.

Recently, Türkiye has emerged as a favored destination for medical tourism, including bariatric procedures such as obesity surgery. Here are some reasons why families might contemplate Türkiye for weight loss surgery for children and teenagers:

Overview

1. Cost Efficiency: A primary motivation is often the financial aspect. The expenses for surgical procedures in Türkiye can be considerably lower than in many western countries, without necessarily compromising on quality.

2. Highly Skilled Surgeons: Numerous surgeons in Türkiye have received education or further training in Europe, the USA, or other developed nations. This has led to a high standardization and excellence in surgical practices within Türkiye.

3. State-of-the-Art Facilities: Many hospitals, focusing on medical tourism, showcase cutting-edge facilities and equipment that meet or even surpass western standards.

4. Integrated Care: Certain centers in Türkiye offer comprehensive care packages that encompass the surgical procedure, hospital stay, post-operative care, and even a stay in a recuperation resort.

5. Geographic Location and Tourism: Türkiye’s central geographic location, its easy accessibility from various countries, and the option to couple the medical stay with a vacation in a country rich in culture and scenic beauty serve as added attractions.

6. Cultural and Linguistic Proximity: For many patients from the Middle East, North Africa, and some European countries, the cultural and linguistic closeness to Türkiye can be an advantage.

Important Considerations

While there are numerous reasons to contemplate Türkiye for medical procedures, families should exercise caution and conduct thorough research before making decisions. It’s pivotal to vet the hospital and medical team beforehand, take into account testimonials from other patients, and ensure long-term post-operative care, especially considering that follow-up appointments in a different country might be challenging to arrange.

Obesity surgery for children and teenagers represents a significant and life-altering procedure. Hence, various prerequisites need to be satisfied before considering such surgery:

Prerequisites for Weight Loss Surgery in Children and Teenagers

1. Medical Indication:

   • Severe Obesity: Typically, a bariatric procedure is considered when a Body Mass Index (BMI) is substantially above the 95th percentile for the child’s age and gender.
   • Co-existing Medical Conditions: The presence of obesity-associated diseases like Type-2 diabetes, sleep apnea, or hypertension might amplify the rationale for the procedure.

2. Previous Weight Loss Attempts: The child or teenager is expected to have already undertaken structured weight loss programs encompassing diet, exercise, and behavioral therapy without long-term success.

3. Psychological Assessment: It’s crucial to ensure the child or teenager comprehends the implications and expectations of the procedure and is emotionally and psychologically prepared for it.

4. Maturity and Understanding: The child or teenager should have ample understanding of the procedure, post-operative requirements, and lifelong alterations related to diet and lifestyle.

5. Consent of Legal Guardians: As children and teenagers are legally incapable of making independent decisions about medical interventions, the consent of the custodial parents or legal guardians is requisite.

6. Multidisciplinary Team: The decision should be based on the evaluation and recommendation of a multidisciplinary team comprising pediatricians, nutritionists, surgeons, psychologists, and other professionals.

7. Long-term Commitment: It must be clear that the patient and their family commit to lifelong follow-up and lifestyle changes to ensure the success of the surgery.

8. Final Medical Examinations: Comprehensive medical evaluations are usually conducted before the procedure to ensure there aren’t any hidden health issues that could jeopardize the operation’s success.

In Conclusion 

It’s imperative to highlight that, even with all prerequisites met, the final decision should be tailored individually, carefully weighing potential benefits against risks. It’s also vital to ensure the family possesses adequate support resources to assist the child or teenager before, during, and after the procedure.