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.

The Slimband weight loss surgery offers you a new approach to losing all that extra weight, and keeping it off. This weight loss surgery is made to help you to lose the weight in a healthy way while helping to teach you proper eating habits.

Any one and everyone can lose weight. It just depends on your diet, and your will to lose that weight. You will need to exercise, and eat right in order for that to happen. You can get help if your struggling with obesity by means of a weight loss surgery if need be. But that is only for some of the overweight people who need to lose the weight fast. It takes motivation to keep a diet on the right track. If you diet and lose weight you have to be motivated to keep that weight off or it will come back on.

The Slimband weight loss surgery will allow you to keep that motivation. If you have paid for this surgery then you should have the motivation to keep that weight off.

Within the first year of getting this surgery, and following a proper diet and exercise you will lose up to forty eight percent of the extra weight and fat on your body. This is not a cosmetic surgery that will suck the fat out of you. It is just an enabler. It helps you to lose the weight.

The Slimband procedure is very much like the Lap Band procedure. The Slimband places a laparoscopic band at the top of your stomach that will control how much food can go into your stomach. Basically this system will help you to eat the right amount that you should be eating in order to lose weight.

An access port to the lap band system is located just right under the skin. So it is in easy access if you ever wanted to adjust the band. In order to adjust the tightening and loosening of the band they will adjust the amount of saline in the ring. The more saline that they put into the ring the tighter the band will be, and the more saline that they take out the looser the band will become.

This surgery is invasive but minimally. Which causes for a shorter healing time, and then the more you can lose weight because you don’t have to wait forever before you can get back out there, and start exercising again.

The Slimband weight loss surgery supports you in the best way that they can. They even include a post surgery support program. The program takes place at there facility in Toronto, although they have a special program that will allow them to keep in touch and support those clients from other parts of the United States. This service will be included in the price of the surgery because it is ultimately a need that you must have support after this surgery, because it could be difficult for someone to fully recover without having someone to talk to.

So now you know a little bit more about the Slimband system. By now you might have decided whether or not you want to have the Slimband surgery done to you. But you also may not be sure. There is more information on the Slimband that you can find online, or by asking your doctor.

As lap band surgery, also referred to as the slim band surgery, has direct physical impact on the stomach, an ulcer is one of the things that one should not be suffering from to go for this procedure. The reason for this can be better understood if we take a brief look at the procedure. An inflatable band which is much like a donut in shape is placed on the upper part of the stomach. The band reduces the size of the stomach, thus reducing the amount of food that it can hold at one time. This results in the decrease of diet and thus loss of weight. The position of the band is decided according to the reduction in size that is required. Once placed, the patient can get the position of this band altered if needed by undergoing a simple and short simple procedure called a lap band adjustment.

The procedure clearly shows that the stomach is physically affected by the lap band surgery and thus the presence of ulcers of gastric nature has to be checked for before the surgery is undertaken. This can cause harm to the stomach and can cause further problems for the patient. Obese patients who opt for this surgery may be already suffering from diabetic or heart-related problems and thus it is very difficult for them to face additional issues.

To understand this problem further, let’s try to understand what an ulcer is. An ulcer is an “abnormal condition of the mucous membranes due to over exposure to HCL or Hydrochloric Acid.” This acid is produced in the body to aid digestion, but if for some reason too much of it gets accumulated in the stomach due to irregular eating habits or over-production, an ulcer is formed. Another cause for an ulcer is a bacterial infection, which can directly damage the membranes. The basic symptom of an ulcer is the regular inflammation in the stomach. A mild inflammation can be felt in the stomach when we are hungry or have not eaten at the daily time. This happens because HCL reaches the stomach to digest the food at the routine time. However, if too much HCL reaches the stomach, it can start causing harm which can be felt as excessive inflammation.

Now, if the patient is suffering from such a condition and he undergoes lap band surgery, the ulcers will only get worse. The worsening can go as far as to damage the stomach walls or even cause bleeding from the mucous membrane. This can lead to malfunctioning of the whole digestive system.

Normally this procedure is carried on the people who, because of their obesity are not able to recover from other problems like heart disorders and diabetes. Thus to make the recovery possible and then quicker, they have to loose weight. With the immensely growing popularity of fast food among people of all ages, obesity has become more of a pandemic. It does not seem to be as much of a danger as it really is, but the side effects that come with, can take lives as easily as any other disease.

Considering all the benefits of this surgery, it’s a very good option. But considering the side effects of undergoing this procedure while suffering from ulcer, one should try to avoid doing it or seek professional advice from several resources before opting for the surgery.

There are some hospitals that have specialized in weight loss procedures and work with banks to assist a patient with acquiring funding. They can offer a number of finance options such as a home equity loan. As well, there are a number of alternative lenders that offer loan programs for the weight loss procedure. You have to make sure you are advised about such aspects as the interest rate (fixed or variable,) and the length of the repayment plan. There are also financial institutions that specialize in providing financing for healthcare expenses such as co-payments, deductibles, and procedures not covered by insurance, including weight loss surgery. Some of these finance companies will provide no-interest and extended payment plans.

The Internal Revenue Service permits deductions for those who pay for weight loss surgery that is not covered by their insurance provider. One can deduct the total of any medical expenses “that are more than 7.5 percent of their gross income.” You should consult with your financial advisor to learn what part of your expenses is deductible.

Before you seek out alternative methods of financing, make sure you check your insurance policy to see if you are covered. Under the heading that says, “What Is Covered” or “Covered Expenses,” there will be a list of what is covered and what is excluded. Look for a statement that says the provider excludes coverage for “weight control, for the treatment of obesity, for the surgery for weight control, or for the complications of the surgery for weight control.” Many insurance providers will cover weight loss surgery if it is considered a treatment that is life saving.

If you are considered obese, weight loss surgery can actually save your life. Diabetes, heart disease, high blood pressure, etc., are all conditions that can put your life at risk. It is important to make sure you can pay for the surgery by doing your research and consulting with the appropriate financial advisors.

After a Lap Band procedure, one has to follow a strict dietary program to prevent vomiting and stomach tissue from sliding through the band. One to two weeks after surgery, one should consume only thin and clear liquids that contain an appropriate amount of calories. Water is essential to keep hydrated. Foods can consist of broth or soup that does not have any solid foods. Fruit juice and skim milk can also be consumed.

After three to four weeks, one can start consuming thicker foods in the form of purees. The purees should be rich in protein. Pureed skinless chicken and fish are good choices. You should also be consuming pureed fruits and vegetables.

Protein is particularly important following Lap-Band surgery. After Lap-Band surgery, the stomach will not be able to hold more than 4 to 6 ounces per meal, so it is essential to make sure you get the appropriate protein that is required by your body. Lap-Band patients should consume fifty to sixty grams of protein daily to avoid protein deficiency. Protein deficiency causes muscle weakness, depression, low blood pressure, hair loss, fatigue, edema, anemia, and in extreme cases, death.

Two months after surgery, patients should be on a modified liquid diet. This is food that is shredded in a food processor along with a high protein shake. The patient must consume two ounces of a protein every hour for ten to twelve hours a day. The basic foods during this time are meat, protein, vegetables, and salads. As well as protein foods, you should have two ounces of other liquids such as soup, baby food, or sugar-free gelatin.

When you are able to eat solid foods without problems, remember that your lap band is designed to restrict solids so you have to watch want you eat. Drinking liquids during or immediately after meals will aid in flushing the pouch. Chew your food thoroughly and eat small bits at a time. Eat only three meals a day and make sure these meals contain adequate nutrients. Your stomach can only hold about ¼ cup of food, or 2 ounces, at a time. You should be able to eat such foods as tender cooked foods fish and ground turkey. If solid foods cause nausea and vomiting, go back to the liquid diet. Then, slowly include soft foods and eventually changeover to soft foods.

You should not have any caffeine for the first three months after surgery. As well, carbonated beverages should not be consumed to avoid gas, bloating, and an increase in stomach size. You should also avoid foods that are high in fiber, dried, spicy, starchy, and fried.

After Lap Band surgery, it is critical that one sticks to the appropriate diet. If not, serious complications can occur that may require further surgery.

There are many factors that contribute to obesity. They can include a lifestyle of very little physical activity, genetic predisposition, poor diet, eating disorders, certain medical conditions such as hypothyroidism, not learning the proper way to eat as a child, emotional issues such as depression and low self esteem, as well as poor metabolism. Whatever the reason for the cause of obesity, one must consider the health implications of obesity.

The following health problems associated with obesity has become a major factor determining factor when considering weight loss surgery.

Heart Disease: People who are obese are at a higher risk of chest pain, angina, heart failure, and a heart attack.

Stroke: Excess fat increases the risk of a stroke due to narrowing of the arteries caused by high blood pressure, lack of exercise, and high fat diet.

Diabetes: Researcher shows that obesity is linked to diabetes. Diabetes is serious illness that requires a lifetime of medications.

Cancer: Obesity has been linked to a number of cancers such as kidney, gall bladder, breast, prostate, and colon cancer.

Liver Disease: Research has shown a connection between body mass index (BMI) and the extent of liver damage. Generally, the higher the BMI, the worse the liver disease. This is also true for gall bladder disease.

Respiratory Problems: Obese people are at a higher risk of lung conditions that affects their ability to breathe normally. Laboured breathing also puts added strain on the heart.

Joint and Bone Problems: Obesity is associated with an increase in conditions such as arthritis and osteoarthritis.

Weight loss surgery is a serious decision that patients make with their doctors and other health professionals. It is normally provided to people who are at a high risk of developing a disease or serious medical condition. It is not a cosmetic procedure, but often a lifesaving surgery. Candidates must be at least 100 pounds over your ideal weight and ready for a permanent weight loss solution. Most times one will elect to have weight loss surgery after they have tried more traditional means of weight loss such as diet and exercise.

Because obesity can affect people in a variety of ways, it is important to consult with a doctor about the risks and benefits. Candidates have to be willing to make serious life changes. If you are an obese person who has tried most traditional weight loss programs, and have failed to achieve healthy weight loss, surgery may be a good option. Make sure before you have surgery that you consult with your regular physician. Weight loss surgery is not a quick fix to losing weight. One has to be committed to a long term healthy lifestyle.

What Is Lap Band Surgery?

Basically, in this procedure a small incision is made and the band is inserted and fastened around the top part of the stomach. Later, when the port is healed, the doctor will inflate the band to squeeze off a part of the stomach, creating a little pouch at the top. The amount of food that will fit into this pouch is very little, usually just a few mouthfuls.

The band can be inflated more or deflated to provide just the right amount of pressure on the stomach for optimum weight loss for the patient. The procedure itself takes around an hour to perform and has become a simple process with the latest techniques and technology.

How Long Is the Hospital Stay?

Each patient is different, but the majority of patients will be able to leave the hospital 24 hours after the surgery. This is obviously dependent on whether or not the lap band was the only surgery performed, since some patients prefer to combine this with another surgery, such as a hernia repair. It will also depend on whether or not there are any complications. The most common problem is infection, which is always an issue with any operation. Another issue may be a latex intolerance, in which case the band would need to be removed.

After 24 hours, if the doctor feels that the lap band patient is recovering well, he will be discharged. While you can go home at this point, it`s not recommended that you drive, lift anything heavy or head back to work for at least another four to six days. Most people need to take at least a week off from work to recuperate from the surgery.

Recovery from Lap Band Surgery

For the first few days after your surgery, you`ll only be able to drink clear fluids, like juice or broth. Avoiding solid foods will let your system recover and give your body time to heal. Once you start eating again, it`s a good idea to begin with soft, bland foods to avoid potential irritations. Vomiting is to be avoided at all costs since it can stretch the pouch formed by the band and make the band less effective in the long run.

For anyone who has spent years struggling with their weight and all the health issues that come along with having to carry too many extra pounds, lap band surgery could be the answer. Less invasive than gastric bypass, it`s also a reversible option which appeals to many, and the hospital stay is short and easy as long as there are no complications.

Why Patients Need Support

Having surgery, even a minor one like lap band, can be traumatic and scary. Afterwards, a patient may wonder if what they are feeling and experiencing is normal. They can ask their doctor, of course, but many people also like to hear from peers, those who have already gone through the same thing.

Lap band patients who have varied means of support are almost always more successful than those who try to go it alone. This is simply because it can be difficult to motivate yourself at times and having others around you to rally and give a boost is a huge help.

Support comes in many forms. Having someone to talk to about food and diet is very helpful for someone who is new to the lifestyle. For those who aren`t used to working out, having others to go to the gym with can be a great motivator. Often, family and friends just don`t work out as the best motivators, since they will tend to be more forgiving of behavior than those who aren`t emotionally attached to the patient.

Where to Find Support

Part of the weight loss process following lap band surgery is having someone to be accountable to. This might be a friend or family member, but often, people do best when they have a support group of people who understand what they are going through, other patients, for example.

Many hospitals that offer this type of weight loss surgery will hold support groups where those who have lap bands can meet and discuss their experiences. It can be very helpful for a newbie to hear what others have gone through and how they dealt with things like diet restrictions and exercise. Everyone has been through the same thing, so this can be a very useful type of support.

Another kind of support that can be very useful is a partner or partners in training. Since exercise is a vital part of losing weight even with a lap band in place, being motivated to go to the gym or head out for an hour of jogging every day can be difficult. That`s why it is very helpful to have an accountability partner to share ups and downs with. Simply knowing that someone else is going to know if you don`t work out is often enough to keep patients on track.

Online groups have formed for post-surgery lap band patients, as well. These should not be used to diagnose problems, but they can be very useful for patients who aren`t sure if what they are experiencing is normal or not. Discussing this with others online provides an arena for support that doesn`t require face to face interaction and is available 24-7, and anywhere in the world. Online groups are particularly popular for those living in more isolated areas or people who don`t have many friends to interact with face to face.

It`s important to have people that have been through the same experiences after a procedure like lap band surgery. There are many options available to the post surgery patient who needs someone to talk to, but perhaps the best thing to do is research these options before the surgery so as to have them at the ready afterwards.

The capability for health issues due to starvation was also a major issue. When the lap band was made, the manufactures looked to minimize plenty of the risks that were inherent with this type of bariatric operation stomach bypass surgery. For example, starvation was significantly minimized a well as downtime. Also, as it concerned no cutting or stapling, there are less post operative complications than with other gut bypass related surgeries. This isn’t to assert the lap band procedure does not carry any risks, so it’s best to chat with a doctor about potential issues before undergoing any major, elective operation.

The band, which attaches to the stoma, permits someone to eat less but sustain a sense of being full.

It’s also reversible, meaning it can be removed with virtually no complications for the recipient, something that couldn’t be related for the old school stomach bypass surgeries.

These advancements have made this actual type of gut bypass surgery safer. As the lap band is adjustable, it can be altered to match the patient’s wishes any time after surgery. It may also be entirely removed laparoscopically. The infirmary stay is mostly extraordinarily short as well, and folks can get on with their lives reasonably quickly after surgery. Folks who select the lap band strategy also shed the pounds far faster than people who go the normal diet and exercise route alone. They also find it less complicated to lose pounds and to keep it off for good.

This is usually because the lap band can help an individual with an amazing weight to lose stay on course by helping them feel full and eat less. Alongside diet and life changes, the lap band can help folks who are serious about weight reduction shed pounds and lead more healthy, happier lives. So far as it is going, lap band procedures are nearly as safe as any major surgery. Associated gut bypass hazards are significantly reduced by the proven fact that no cutting or stapling is concerned. The lap band system is also reversible and less than 1% of patients report any totally serious concerns. If you have an interest in lap band surgery do your homework and consult with a licensed surgeon with experience in the field before making any firm calls. By taking time to research the process you’ll make an educated call and greatly decrease any risks related to lap band surgeries. This can make sure that you get the outcome you have dreamt of, that the body of your dreams.

To find out the costs of the lap band surgery you should contact some of the lap band clinics in your area. In general, the surgeon prices will be affected by where that doctor is practicing. If it’s in the United States, the costs range from $20,000- $27,000 where as in Canada the procedure is offered for just around $18,000 CDN, which really comes out to $14,500 USD. Other options include Mexico and India, where the surgery can be done from anywhere from $6,000 - $14,000 USD.

As you can see, the price range for the lap band, or adjustable gastric banding procedure, is cheaper than the other types of weight loss surgery, with the classic gastric bypass cost being more expensive at around $28,000 - $32,000 USD in the United States. Plus, that type of surgery is much more dangerous and has less success rate when compared to the gastric banding (lap band) procedure. Remember if you’re considering any type of weight loss surgery to do all the proper research, and if you’ve decided on the lap band surgery make sure you find a lap band clinic that fits your needs and your price range.