Obese teens are increasingly turning to surgery and drugs for weight loss. While these options may be appropriate for some obese adolescents who face serious weight-related health complications, they are not a first-line treatment. Neither surgery nor medication should ever be employed before nutritional and exercise changes have been given an adequate time to work. In addition, drugs and surgery may be perceived as a quick fix to a problem that requires long-term strategies to overcome. In the end, using these methods is a decision to be made on a case-by-case basis with your teen and your doctor.

Weight-Loss Drugs

Prescription medications Meridia (sibutramine, from Abbott Laboratories) and Xenical (orlistat, from Roche Pharmaceuticals) have shown some effectiveness in treating teen obesity. Orlistat works by blocking fat absorption, and sibutramine suppresses appetite. Orlistat received FDA market clearance for use by obese teens in late 2003. The drug does have some potential side effects, including possible gas and stool leakage. It can also impair the absorption of some fat-soluble vitamins, requiring daily multivitamin supplementation.

The FDA has not cleared Meridia for use by teens, but clinical studies have demonstrated its effectiveness in this population. However, Meridia has come under fire by consumer watchdog group Public Citizen, which claims that the drug may be linked to heart-disease deaths. Both the manufacturer (Abbott Labs) and the American Obesity Association deny that claim, and to date there is no published clinical evidence supporting it.

Drug therapy is usually only recommended for those teens who are significantly overweight and who have been unsuccessful in losing weight via lifestyle changes. It's important that they keep up those lifestyle changes, however. A weight-loss drug is just a temporary aid in fighting fat, and one that can't work alone indefinitely.

Gastric Bypass

A growing number of teens are undergoing gastric-bypass, or bariatric, surgery. This invasive procedure involves reducing the size of the stomach so that it only accommodates a small portion of food. While it can facilitate dramatic weight loss, it is a permanent and major lifestyle change and should not be considered lightly. Teens considering bariatric surgery should be carefully screened for both their physical and psychological readiness for the procedure.

After the surgery, teens must take vitamins and minerals (particularly calcium carbonate, to prevent osteoporosis, and iron supplements) for the rest of their lives. If they attempt to eat more than their stomach will accommodate (less than one cup) or have foods high in fat or sugar, they experience severe gastrointestinal distress and nausea. They must also drink small amounts of water and sugar-free beverages throughout the day to prevent dehydration.

The International Pediatric Endosurgery Group (IPEG) has set the following guidelines for selecting adolescent candidates for bariatric surgery:

• Candidate must have a BMI of 40 or higher with serious medical co-morbidities (such as Type 2 diabetes or obstructive sleep apnea), OR

• Candidate must have a BMI of 50 or higher with minor medical co-morbidities (such as hypertension, high cholesterol).

• Candidate must also meet all following criteria:

  • Have reached (or nearly reached) full adult height

  • Be capable of following postoperative care and nutrition guidelines

  • Be willing to undergo a psychological examination

  • Have undergone a minimum of six months of conventional weight management attempts (diet and exercise) with poor results

  • Agree to not become pregnant for a year after the surgery