Slim Band Surgery is a proven method of losing a large amount of body mass. Slim band surgery involves inserting a gastric band that will reduce the size of the stomach causing recipients of the surgery to ingest smaller amounts of the proper foods in the proper consistency. The gastric band is placed around the upper portion of patient’s stomach which divides it in two sections. The silicon band is a hollow ring, which will be filled with saline to increase or decrease the opening. This procedure is very much different plastic surgery like liposuction in which fat is being sucked out and removed from the body.

During the weight loss period following the surgery, patients will lose weight in a healthy and practical way. This allows the patient to not only lose the weight, but learn how to eat the proper foods in the proper portions. This method of weight loss is a proven method of maintaining permanent weight loss. It is one of most effective and reliable surgeries to help an obese person lose weight.

Having weight loss surgery involves preparation before the actual surgery. Below are a number of tips to preparing for slim band surgery:

1. It is important to learn everything about slim band surgery. Talk to the slim band surgeon, your physician, and others who have had the surgery. There is also a wealth of information online. You should find out about how the surgical procedure is performed, the results, side effects and possible complications, how to prepare for the surgery, and what you have to do during the recovery period.

2. Find out what you products you should avoid such as specific over-the-counter medications as well as prescription medicine. You should find out how long before and after the surgery these products should be avoided.

3. When you smoke and drink, it will increase the risk of complications and can slow the recovery period. It is important to quit smoking and not drink alcohol at least 2 weeks prior to the surgery.

4. Because the surgery is only about an hour and you will be able to go home that day, it is important to have someone drive you home after the surgery. Also, you will need to have some one with you to help during your recovery period.

5. Make sure you have the necessary prescription drugs you will need during your recovery period such as pain mediation. These medications should be nearby during recovery. Other items you should have acquired prior to surgery are a thermometer, bandaging/dressings, and anti-bacterial soap. Contact your doctor about all of the specific items you will need during recovery. Remember, for the first 6 weeks you will not be engaging in strenuous activity and after 3 weeks, you be starting to return to regular activities.

6. Choose the clothing you will be wearing on the day of surgery and during the recovery period. Wear loose fitting clothing that is comfortable. You don’t want to pressure or aggravate the incision.

7. Follow your doctor’s orders about the foods you should be eating prior to surgery. Also, you can prepare physically. This can include: performing light exercises such as stretching or walking, get a hair cut, shave your legs, scale back portions of food you consume, practice relaxation techniques. Also make sure you get a complete physical that includes measuring blood pressure and heart rate.

Slim band surgery is an innovative way to drop excess weight, improve your health, and extending your life. It is the most non-invasive weight loss surgeries with minimal risks and it is fully reversible. Like any surgical procedure, it is important to make the proper preparations to ensure a successful recovery.

Many people feel uncomfortable with taking time out for themselves. This surgical procedure will require you to resolve any anxiety you may have about depending on others. You will need to take as much time as needed for your body to presume its natural functions. The pre and post examinations will be the foundation of which you need to base your recovery plan from. Allowing others who are committed to your well-being to be privileged to the information you have about your health is crucial.

Feeling comfortable with communicating your experience to your doctor is crucial to the development of your healing. Each person will respond differently to the procedure and will need to be tuned in to the experience of their body. You and your doctor can develop an amazing experience by how well you work with one another.

Having the proper diet and exercise will promote faster weight loss with a slimband procedure; however your doctor’s permission is needed. Taking on more than you should will foster unhealthy risk factors within the recovery plan. A couple of weeks of rest is generally required before committing yourself to beginning an exercise regimen.

Having a meeting with your employer prior to your surgery will provide you the peace of mine you need. This is a way for them to delegate your responsibilities while you are away; which will allow you to focus on your health. Taking time to assess what kind of help you will need on the home front is a great way to invite people you trust to participate. Knowing how and when to ask for assistance is a display of courage.

Generally, one could probably get back to work sooner than expected. However, this is not always a good idea for a variety of reasons. First of all your incision must be kept clean for it. You will not be able to do as much as you think so begin thinking about it differently now. Preparing your mind and spirit is just as preparing your body so be committed to be cooperative and positive.

There is no question that surgery of any kind will create some trauma to the body; be clear about what you can expect. A treatment plan will be provided to you by your medical doctor and you will want to make sure to follow it closely. It will be beneficial to share the information with people who will help care for you while you are out of commission. The process will be more cohesive once everyone knows what to expect and how to proceed through your journey; remember to be cooperative.

Your body will be the main source of communication while you are getting through the healing experience. It would be beneficial to adhere to the doctor’s orders so that the body can trust that recovery is happening. It is the only body you have so be certain to allow it to be as vulnerable as it needs to be – its temporary and will pass.

Let your support team be of assistance to you when you need help as this will enhance your chances of having a speedy recovery. Face the fact that the most challenging circumstances must some times be approached with a village of people in order to keep the ordeal from getting out of hand. Be humbled and graceful by asking others for help and making them feel as needed as they are – this is good for all meaningful relationships.

Slim band surgery can help dedicated consumers lose unwanted pounds when their primary physician approves. There are a variety of things to understand before making a decision to commit to the procedure; so do your homework. Weighing out the pros and the cons will allow you to be fully engaged in the recovery process; and achieve the results you deserve.

Starting an exercise program should be done slowly and gradually. Once patients have gotten used to the routine they are doing as a workout, they should begin to include into their routines every day. The sedentary lifestyle will need to come to a halt.

Dietary changes will also need to take place in the preparation for this procedure. Changing to a complete healthy diet and eating smaller portions will help prepare patients for the lack of caloric intake after the surgery.

Checking Out The Pre Surgery Diet Plans

In the few months before the surgical procedure, patients should take steps to begin cutting the portions of food they eat into much smaller ones than usual. This is going to help a lot in getting used to this type of light diet after the procedure is over.

The need for the liver to shrink before surgery is vital to prevent unnecessary blood loss and to reduce the degeneration of muscle. This can be done effectively by closely following the diet outlined by the doctor. The particular diet he or she might prescribe will be one of 800 to 1200 daily caloric intake that is rich in proteins and nonexistent for fats.

A strict liquid diet is recommended during the two weeks prior to the lap band surgery.

Smoking cigarettes will need to become a habit of the past. Drinks that contain sugar and are carbonated are no longer allowed either. Increases physical exertion through exercising is advised at this time as well.

The Post Surgery Diet Is Important

After surgery, patients will undergo a slow recovery back to a normal diet. This recovery time can easily last four to six weeks. Only ice ships are allowed the same day after this procedure is done. This is the first of four steps in the way back to eating regular foods.

Two weeks after the the first day will require patients to remain on a diet that is made up of only clear and thin liquids like broth. No chunks, even the smallest ones, of food are permitted to avoid regurgitation. This could cause damage to the surgical site and to the placement of the band as well. Any dairy products, sugary and caloric beverages are not allowed.

Once the patient experiences success through out the liquid diet, doctors usually permit eating certain foods that are pureed. These are foods that will have the same consistency as baby food. The foods patients will be allowed to have in the pureed form will be listed by the doctor.

The introduction of solid foods will need to done in certain way. Pieces should very small and foods should be chewed into fine consistency. This is to ensure no nausea and vomiting.

The doctor will also advise you to not drink beverages after meals or during them as well. This will aid the food to pass too quickly, thus the whole reason for the band will be defeated. Many patients do well by starting out with small bites of turkey or chicken.

Remaining on top of dietary changes and adapting to them is the key to the successful surgery. Eating smaller meals with smaller potions will take time to adjust to, but it will be a lot easier with the lap band in place.

Taking A Look At The Long Term Dietary Changes

When patients are eating the regular diet of solid foods, they should remember to nor drink with meals and to chew their food well before swallowing. Popcorn, asparagus, and nuts are some foods that will always need to avoided. Those foods high in calories, sugars, and fats will also need to avoided. Mark carbonated drinks off the list for the patient that has this surgery.

People that have undergone lap band placement should know their mental status is affected as much as their physical one is. Making the necessary healthy lifestyle changes needed to have long term success with a lap band is important.

Expected Amount of Weight Loss

Most doctors and nutritionists agree that losing up to two pounds a week is a healthy amount of weight to lose for the average person. Even people who exercise regularly and switch over to healthy diets should expect to lose weight at this rate. Keeping up with a healthy weight loss routine, according to this rate, may result in a person weighing up to 100 pounds less, which is amazing.

After receiving slim band surgery, you should be losing weight at a rate of 1.1 to 2.2 pounds, and this is considered to be a healthy amount. However, there are people who lose weight much more quickly because of their specific circumstances.

Some people may not be able to exercise right after they have received slim band surgery. In this case, weight may be lost at a very slow rate. During this time, though, it is very important that they eat healthfully and start taking on healthy habits, such as eating regularly and avoiding junk food. Once they are able to start exercising, they should expect to lose weight at a much faster rate. In some cases, they may even lose up to five or more pounds per week, which is fine as long as the weight is being lost due to healthy eating and exercise habits.

What to Expect After Surgery

Different people will achieve different results with slim band surgery, and some may not be able to start their regular weight loss routines straight away due to the positioning of the slim band. There are several reasons why results vary, and these include:

* The slim band may not be comfortable for the patient and may require adjustments. It may take several adjustments for the best location to be found.

* Occasionally, the injection port that is used for injecting and removing saline from the band moves to a new location. This an issue that must be fixed by a doctor.

* Patients cannot return to their normal lives right after surgery. They usually have to take special steps to ensure that they do not compromise their results or their health. For instance, it is common for patients to be put on a liquid diet and this may lead to a higher rate of weight loss in the first few weeks after the surgery for some patients. At a later date, patients will be able to eat solid foods again, and this may decrease the rate of weight loss for some people.

It is normal to lose weight at a rate of one or two pounds per week after surgery, and this may improve with regular weight loss once you have completely healed. In order to ensure that you reach your weight loss goals and that you do not become frustrated with your results, you should set healthy and realistic goals, like aiming to lose around eight pounds in a single month. Once you achieve this goal and notice that your body is changing, you will start to feel more motivated and you should also feel very proud of yourself. Setting steady goals will help you reach your ideal weight and once you get there, you’ll only have to focus on maintaining that weight.

There are a few basic considerations that will be made in addition to review of a patient’s history. These typically include the age and the weight of the patient. It is generally recommended that the application be in the range of 18 to 55 years of age. He or she should also be at a minimum of 100 in weight have an approximate BMI or Body Mass Index of 35-39. When The Body Mass Index falls between 35-40 the doctor will work to determine what the effects of weight gain have been on overall health. Those applications whose Body Mass Index is over 40 will not need to have any weight related health issues in order to qualify for the surgery.

Following is a list of additional considerations that are typically made by the bariatric physician in order to determine if you are a qualified applicant for Lap Band Surgery

The Patient’s Medical History

Medical history is a key determinant as it will help reveal your ability to endure and recover from an invasive procedure. For example, patients that have cardiovascular issues or blood clotting issues have a far greater likelihood of experiencing serious complications following a surgical procedure.

If the cause of obesity is directly related to an illness, this may also be cause for ineligibility. When the applicant is unsure of the cause of weight gain it is usually recommended that he or she undergo a thorough medical examination before the consultation for the procedure is made.

Does The Applicant Smoke?

Smokers have a much higher rate of post-op issues than individuals that do not smoke. These serve to lengthen and complicate recovery. If an applicant is earnest about a real lifestyle alteration their best tactic is to implement a quit smoking program before opting for the surgery and undergoing consultation.

Lifestyle Habits and Choices

There are several lifestyle choices that make an individual a less than ideal candidate. Living a routinely sedentary life that is hectic and filled with stress as well as opting to consume high amount of junk food could be problematic. These may be habits that you doctor will ask you to change before the surgery. Often if this is too hard for a candidate he or she can get help from a certified behavioral specialist who can help the candidate learn more beneficial attitudes and habits before the candidate will be considered.

The applicant’s history of exercise and diet

Many ethical physicians work hard to determine that the applicant has been diligent in trying other methods of weight loss and that there has been consistently limited or no success. This is the way to avoid misuse of the procedure as a first measure or radical cure all for excess weight gain. Individuals that have been diligent in other weight loss efforts are also known to be more diligent about following the lap band exercise and meal plan after the procedure has been performed which is key to the success of the operation.

Pre-Operation Testing

Several other measure are taken in order to ensure that any lap band surgery is a success. The bariatric physician will likely want to run a host of diagnostic tests to best understand your continued health and viability for the procedure. These tests might include CAT-scans, ultra sounds as well as blood and urine analysis. If the results of these are normal the applicant will then progress to another level of evaluations, where mental preparedness is likely observed. Following the comprehensive collection of relevant data a qualified applicant can then begin the lengthy pre-op preparations for lap band surgery

Could the lap band be the right solution for you?

If you are committed and ready to lose the weight and keep it off and are prepared for radical lifestyle alterations, now is the time to make contact with a local bariatric physician that is properly certified and able to offer you a consultation. During the consultation you will learn more about the procedure including the risks that are associated. The physician will then place you under evaluation to make certain that the lap band procedure is the right solution for you.

Your desire to look better and feel better is the first and most important step towards a rich and rewarding life. While maintaining a strong and positive mindset, the lap band will help you reach these all important goals.

This tranquility may be slightly shaken when one is diagnosed with a critical ailment. Even in chronically affected patients, age can have detrimental effects on hope of recovery and dreams of living a normal life. It would not be fair to say that trauma of critical illness is all in one’s mind. Far from it in fact: each person’s battle with illness is a very real issue, compounded by pain, dependency on a care-taker even for simple movements and the consciousness of ebbing confidence. Fortunately, there is a possibility to help oneself even in this dark hour or such diagnoses: the answer is critical illness insurance Canada. It can greatly avoid the ill effects of shock and feelings of finding oneself short-changed. It gives the poor but heartening confidence that material resources can, by showing that all is not lost, and there is a light at the end of the darkest tunnel.

Canadian health insurance plans are intuitively designed to make the way easy for those who have special and definite needs, and critical illness insurance in Canada is one of the many plans that offers ample coverage and treatment options access when it is most needed. It is not untrue that chronic and sometimes terminal diseases surface even at a young age, and while one can make an educated assumption by going through family history and lifestyle habits it is always a wise decision to have a protective net in the form of coverage against critical illnesses. It is possible to have plans chalked out for ailments which have greater propensity for occurring in each individual, either way you need to ensure that you are covered in case of a health emergencies and critical illnesses.

In spite of the heavy cost, the dramatic results ensured made Lap band surgery cost in Canada a plausible option and many people affected by obesity take it up as the last course of action. Also, there are no crash diets and exercise regimens to be followed after the surgery. It is just a single investment which can bring one back into shape to a great extent. You can consider yourself lucky if you can find a hospital where you can get the operation done $ 16000 — $ 18000. The first step to try this is to see if you qualify for weight loss surgery.

It is usually recommended for people whose Body Mass Index (BMI) is above 40. In some special cases like patients with comorbidities which may improve upon weight-loss, it is even recommended for people with BMI 35-40.

Look for clinics that offer weight-loss surgery where they have hands-on experience with a lot of patients. Make sure you have medical insurance and travel insurance if you have traveled to Canada for the purpose of surgery. Get ready for a new you!

Although the lap band surgery has an extremely low fatality rate, other bariatric surgeries are still considered to be associated with a slight risk, although at the end of the day surgeries are surgeries and you want to make sure you are protected in case your body doesn’t react normally or if something goes wrong with the procedure. The whole point is that you are already at a higher risk than the average person and it’s not fair to leave your family to struggle in debt in case anything should happen to you in both the short-term and long-term future.

When trying to find out more information about the wide range of life insurance providers, you should shop around online to try and find both cheap life insurance as well as life insurance that will actually protect you and not have a minor stipulation that the insurance company will try and exploit to get out of paying you or your family your insurance payout, if you should so happen to require it. Be thorough when doing your research and make sure you ask all the right questions so that there are no unpleasant surprises down the road. Your health is really not something to play around with, and for the sake of your loved ones it’s essential to make sure you have the right health and life insurance policies in place before disaster strikes.

As the obesity rates in the United States continue to rise, bariatric surgery has become an effective intervention for weight loss. Bariatric surgeries range from restrictive procedures such as adjustable lap banding and vertical banding to surgeries involving bypass methods. Gastric bypass (Roux-en-Y) and biliopancreatic diversion (BPD) with or without a duodenal switch (DS) implement bypassing part of the alimentary tract. Bariatric surgeries succeed in resolving comorbidities attributed to obesity and have a mortality rate of less than 1%. However, life-long health problems often emanate from bariatric surgeries—especially from the procedures utilizing bypass techniques.

In addition to anticipated short-term medical problems, patients are also at risk for metabolic abnormalities. Several vitamin and mineral deficiencies have been documented following bariatric procedures including iron. Iron deficient patients suffering from anemia require life-long medical attention. Menstruating females account for the majority of bariatric patients and pose a greater risk for iron deficiency. As such deficiencies can adversely affect the quality of life weight-loss surgery intends to promote, the prevalence of iron deficiency following bariatric surgery requires close examination.

A Scientific Review

A review on the correlation of iron deficiency and bariatric surgery was published in 2008 in The American Journal of Hematology. The review, conducted by Dr Love, included several studies related to the topic. Methods used to collect articles involved keyword searches on PubMed. Bibliographies associated with the studies reviewed were also considered. The objective of the review focused on exploring the association of iron deficiency and bariatric surgery. Love’s review concluded that patient preoperative assessments should include a complete hematological work-up followed by a postoperative prescribed supplement for patients undergoing bypass procedures.

Deficient Iron Levels and Gastric Bypass

Bariatric surgeries of the restrictive nature (lap band, vertical banding gastroplasty, sleeve gastrectomy) are less likely to cause iron deficiency and iron deficiency anemia than those of the malabsorptive nature (Roux-en-Y, BPD-DS). A significant majority of related studies indicate deficient levels of iron ranging from 6% up to 50% in bypass patients at different time periods following surgery [1].

Contributing Factors of Iron Deficiency

Dietary Intake

Some studies suggest that gastric bypass patients consume less red meat than needed to maintain appropriate iron levels. As red meat provides heme – an organic pigment which contains iron – lower consumption could cause deficiencies. One study documented several cases of the body’s intolerance in digesting red meat following gastric bypass. A patient questionnaire revealed that episodes of vomiting following intake of red meat. A related follow-up over 6 years after surgery supported lack of meat as a factor in iron deficiency [2]. Patients who considered themselves meat eaters recorded higher iron serum levels.

However, iron deficiency cannot be explained solely on the basis of meat intolerance. Here is why: Patients who undergo lap banding generally have even less meat tolerance than gastric bypass patients. Yet, when measurements were compared between the two patient groups in one study, only gastric bypass patients were iron deficient. Therefore, iron deficiency is multifactorial.

Reduced Gastric Acid

Studies investigating gastric acid secretion before and after bypass procedures have shown a much lower level of acid after surgery. This is because bypass surgeries decrease the number of parietal cells in the stomach, which are responsible for gastric acid production. As a result, gastric acid supply lowers [3]. In the case of gastric band however, the digestive tract continuity stays intact. For this reason, patients undergoing banding procedures have much less risk of iron deficiency or other nutrient deficiencies than patients who opt for a bypass operation.

Bypassing The Duodenum

When bariatric procedures bypass the duodenum digestive continuity is interrupted. The duodenum absorbs heme. Because bypass surgery excludes the duodenum, obviously heme can no longer be absorbed meaning less iron enters the digestive process. Bypass patients record a much lower level of hemoglobin and serum iron than patients undergoing banding surgeries [4].

The importance of the duodenum in iron deficiency is shown in biliopanceratic diversion procedures. In biliopancreatic diversion with duodenal switch (BPD-DS) part of the duodenum is preserved. In contrast, in biliopancreatic diversion without duodenal switch (BPD) the duodenum is completely excluded from the digestive system. It is not surprising that in one study comparing the two versions, there were higher serum ferritin levels in the BPD-DS patients .

Additional Factors

Bleeding may cause iron deficiency [5]. Bypass patients may have gastrointestinal blood loss as a result of loops of bowel no longer assisting in digestion. Ulcers may be another source of blood loss.

Intestinal bacteria can become extensive in the bypassed bowel loops. That damage can cause epithelial cells and the iron they carry to be excreted.

The amount of weight loss and/or the time it took to lose the weight appear to have no bearing on absorption of iron.

Gender and Age Implications

Many obese people have pre-existing conditions of low iron. Females have a higher risk of iron deficiency and other nutrient deficiencies than males in the same age group. One study revealed no iron deficiencies in males while about 75% of female patients were deficient.

Women pose a greater risk than men for iron deficiency and anemia due to menstruation which often results in lower iron storage prior to surgery. Women who continue menstruating after surgery have higher levels of iron deficiencies than those who are past menstruation age. All bariatric surgeries demonstrate lower serum iron levels for menstruating women compared to nonmenstruating women—including banding procedures.

Fertility in women generally improves after bariatric surgery, but the surgery also results in iron deficiency for those women of child-bearing age. In addition, more iron is needed during pregnancy. Risks to the baby and the mother may stem from iron deficiency and anemia. Iron deficiency tends to result in more preterm or low-birth weight babies [6].

Banding procedures may be a better option for women who plan to have children after weight-loss surgery. This is because iron is still absorbed in the duodenum in restrictive procedures.

Gender plays a role in iron deficient rates in obese children as it does in adolescents. As pediatrics deals with higher levels of obesity, more surgical intervention takes place as a weight management tool. These procedures prove to be effective for younger patients by improving quality of life. Mortality rates are low. However, life-long iron deficiency and other vitamin and mineral deficiencies pose a risk—especially for girls [7].

Prevention of Iron Deficiency

Multi-vitamins are usually prescribed for all bariatric patients to address nutrient deficiencies. For high-risk patients such as menstruating women, many surgeons also recommend iron supplements [8].

An increase in gastric acids leading to more iron absorption occurs when vitamin C is added to an iron supplement. Adding vitamin C promotes more absorption by reducing iron to ferrous. A study of patients treated with iron supplements for a month followed by iron supplements and vitamin C the next month, indicated the benefit of the oral iron supplement. During the second month, even higher rates of ferritin and hemoglobin were noted indicating the significance of adding vitamin C.

Summary

Iron deficiency and anemia are risks resulting from bariatric surgeries. Due to the obesity rates increasing, surgical interventions also increase causing long-term deficiencies in vitamins and minerals, including iron. These deficiencies are higher for all females. Within that group, menstruating women, those who become pregnant and some adolescents have the highest risk of becoming iron deficient. Patients who pose risks may need to take oral iron supplements with the possibility of more aggressive treatments required. Bariatric patients opting for banding procedures may have a lower risk of becoming iron deficient due to the non-malabsorptive nature of the surgeries. However, patients undergoing any bariatric surgery should expect the need for medical supervision to monitor hemoglobin and iron for the rest of their lives.

Matt Papa

As a biologist and research fellow at Washington University School of Medicine in St. Louis, MO, Matt Papa, PhD, studies cardio-vascular diseases. A related interest, he follows current scientific research on obesity interventions and effective weight loss methods. Matt’s summaries of professional peer-reviewed journals, as well as other resources, (such as a BistroMD coupon discount and a Diet-To-Go savings coupon) are published on his website to offer support and tips for readers faced with the challenge of losing weight.

References

1. JG Halverson, Micronutrient deficiencies after gastric bypass for morbid obesity, Am Surg, 1986;52:594-598.

2. E Avinoah, Nutritional status seven years after Roux-en-Y gastric bypass surgery, Surgery, 1992; 111:137-142.

3. KE Behrns, Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity, Dig Dis Sci, 1994; 39:315-320.

4. HJ Sugarman, Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment, Am J Surg, 1989; 157:93-102.

5. PP Toskes, Hematologic abnormalities following gastric resection, Major Probl Clin Surg, 1976;20:1190128.

6. RE Brolin, Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies, Int J Obes 1991; 15:661-667.

7. RS Strauss, Gastric bypass surgery in adolescents with morbid obesity, J Pediatric, 2001; 138: 499-504.

8. BM Rhode, Iron absorption and therapy after gastric bypass, Obes Surg 1999; 9:17-21.

Scientific evidence points to morbidly obese pediatric patients facing diseases once thought to affect only the adult population. These children are high-risk candidates for serious problems of a physical, psychological and metabolic nature. For the most part, this targeted group does not represent typical children who just happen to be overweight. In his paper [1], recently published in the peer-reviewed journal Seminars in Pediatric Surgery, Dr Caniano points out that morbidly obese children have increased rates of heart disease, sleep disorders, high blood pressure and type 2 diabetes. A significant percentage of these pediatric patients’ serious medical problems will require treatments including prescription medication. Even with treatment, these children will continue to be at risk for premature morbidity as adults, which will contribute to a decline in life expectancy rates linked to obesity.

Some physicians argue that a possible solution in reversing this pattern in morbidly obese children may include bariatric surgery. Bariatric surgery has proven beneficial in morbidly obese adults. Studies show adults lose significant amounts of weight and maintain weight loss following the procedure. However, no long-term studies exist for the pediatric group. The consequences of bariatric surgery for morbidly obese children are unknown. They may or may not be similar to adult studies.

Obligation To Do What’s Best For The Patient

Considering the extreme condition of these morbidly obese children, traditional methods such as a lower calorie diet, regular exercise workouts and behavioral therapy fall short of reversing the consequences of obesity. Studies reveal that substantial weight loss from such typical methods can reduce a patient’s BMI by 3% after a one-year period of medical supervision in an intensive weight loss program. But, for children in this group with a BMI of over 40 kg/m2, it’s not enough [2]. Therefore, patients and families in this particular group should be provided with information on surgical options. This information should be specific in nature including risks and benefits. They should be given resources to counseling and further consultation. In order to serve the best interest of these patients, a doctor would be obligated to present this alternative [3].

On the other hand, for those patients who might lose enough weight to show that a reversal of their continued obesity is possible, a doctor is obligated to continue traditional medical treatment because it would be in the child’s best interest. Surgery would not be warranted.

Continuing the medical responsibility to ensure the best health for morbidly obese pediatric patients, a doctor is obligated to conduct a careful assessment for each patient. In addition, all the traditional methods for weight loss conducted in a hospital setting should fail before surgical intervention is considered, Dr Caniano MD, Professor of Pediatric Surgery, explains. A doctor should also seek the possibility of low-risk clinical trials to address morbid obesity in a pediatric patient.

Obligation To Cause No Harm

Doctors take an oath to treat the sick and to never use their livelihood to cause injury or harm. In that regard, considering the risks of bariatric surgery and the unknown consequences for pediatric patients, there could be a valid argument against surgery.

The two bariatric surgeries performed most often are the Roux-enY gastric bypass (RYGB) and the adjustable gastric band (ABG). Both surgeries come with risks. The RYGB can be done with open surgery or laparoscopically. In those cases where RYGB fails, gastric bypass revision may be considered. Risks include tube leakage, massive bleeding or blocked arteries. Long-term nutritional risks also exist. Patients must take nutrient supplements as directed to reduce risks for calcium, iron, folate, and several vitamin (D, B6, B12, B1) deficiencies.

The AGB procedure presents other risks. Patients may experience complications with infection because the band is a foreign object to the body. There may be mechanical complications as well. It is possible the band may slip out of position or cause erosion of the gastric wall.

To date, an article in Annals of Surgery, presents the most complete review of both procedures based on one-year follow-ups [4]. The report concluded that both procedures led to sustainable and significant weight loss for patients. Both procedures also caused significant complications for patients but there were no deaths related to the gastric band procedure or the bariatric surgery.

The reality of the complications following bariatric surgery may be hard for a young patient to comprehend. A patient and/or the family may think surgery is a quick fix and not think about unanticipated problems. The low rate of serious risks published in the report might cause a patient to underestimate possible consequences. A patient might tend to overlook what it would be like to stay in the hospital for a long time or to undergo a second surgery.

The Question Of Informed Consent

Considering that morbidly obese pediatric patients are under the age of legal consent, parents must sign consent for surgery for minor children. That policy assumes that parents know their children and know what would be in their best interests. It is possible that patients and parents have an optimistic view based on what they see in the public. They are presented with a large amount of information through social media. These venues often highlight success stories and picture former morbidly obese patients in great shape. The media depictions are not always representative of typical cases, but still influence patients and families.

Dr Caniano explains that due to the nature of a surgical intervention, a lengthy process must occur prior to informed consent. The process ensures that traditional methods of weight loss have failed, the patient and family have met with medical professionals and a pediatric surgeon on a regular basis, and they have received in-depth accurate information on risks and benefits of procedures and have taken sufficient time to consider the consequences [5].

Concerning informed consent, the minimum expectations for the amount of information given to patients and families include the following elements:

· Inform responsible parties of the patient’s diagnosis

· Explain details of the proposed surgery

· Discuss risks and benefits

· Determine the patient’s post-operative actions and behaviors needed for success

· Tell about alternatives to surgical intervention

· Reveal financial aspects

The Question Of Justice And Ethics

Obesity rates in the United States are growing at an alarming rate. For children in this country, one in every three in the socially disadvantaged group is obese. African American girls and Hispanic and Native American boys and girls experience particularly high rates of obesity. Due to the fact that children from families who are socially and economically challenged score lower in childhood health indicators than their more affluent Caucasian peers, they may not have access to important information. They may not be aware of resources in medical weight management of bariatric services.

It seems professional advocacy is needed to make sure all morbidly obese children and their families are aware of available services. If obese children require intervention to achieve better health, community efforts should be organized to provide information and resources to these families [6]. Once patients and families are in the hands of pediatric surgeons and other medical professions, all aspects of bariatric surgery and alternatives must be offered in a clear concise manner. All of these steps need to occur to fulfill ethical, medical and societal obligations to the morbidly obese pediatric patient.

References

1. Donna Caniano. Ethical Issues in Pediatric Bariatric Surgery. Seminars In Pediatric Surgery. 2009: 18: 186-192

2. Levine MD. Ringham RM. Kalarchian MA. et. al. “Is family-based behavioral weight control appropriate for severe pediatric obesity?” International Journal of Eating Disorders. 2001:30:318-28.

3. Inge TH. Xanthakos SA. Zeller MH. “Bariatric surgery for pediatric extreme obesity: “Now or later?” International Journal of Obesity. 2007:31:1-14.

4. Treadwell JR, et. al. “Review and meta-analysis of bariatric surgery for pediatric obesity”. Annals of Surgery. 2008:248:763-76.

5. Engelhardt HT. The Foundations of Bioethics. New York, New York. Oxford University Press. 1986.

6. Blacksher E. Ethical and political challenges to seeking justice. Hastings Center Rep. 2008:38:28-35.

Matt Papa, PhD, works as a biochemist at Washington University in St Louis, MO. He has been twice awarded research grants by the American Heart Association to support his research in blood coagulation diseases. In his blog he discusses latest obesity research findings, provides information on popular weight loss programs and gives away a Nutrisystem diet promotional coupon.