Gastric bypass helps diabetic teens

CINCINNATI, OHIO; December 29, 2008

"I really couldn't go anywhere," says Munson. "I wouldn't fit into the seats at movie theatres. I couldn't go running because it just hurt so bad and my heart would speed up too much."

So threatening was Munson's weight to her health that she became one of a growing number of teens who have undergone gastric bypass surgery -- a procedure that has traditionally been used only in adults whose obesity puts their lives at risk.

And in a new, small study, doctors at five medical centers around the country report that the operation indeed appears to improve the health of patients in their teens -- at least in the short term.

For Munson, the surgery may have come not a moment too soon. She was diagnosed with heart problems, high blood pressure and type 2 diabetes.

The Kentucky teenager said she received a dire warning from her doctors: "The doctors said you're not going to live to see 25, if this continues," she says.

On March 12, 2007, Munson opted for the radical and controversial operation, which involves dramatically reducing the size of the stomach and rerouting the intestine. She underwent the procedure at Cincinnati Children's Hospital, and it turned her health around.

"I can honestly say that the last time I took medicine for my type 2 diabetes was ... the day I went in for surgery," she says.

Munson is now diabetes-free and about 100 pounds lighter.

The new study, released today in the journal Pediatrics, studied 11 obese teens who had gastric bypass surgery. Ten of the 11 patients, ages 14 to 21, saw their diabetes go into remission. They no longer needed to treat the disease.

"I think the bottom line is we, for the first time, documented in an extremely obese teenage group of diabetics that weight loss surgery is effective for weight loss and that it results in disappearance of diabetes," says study lead author Dr. Thomas Inge, surgical director of the Cincinnati Children's Hospital's Surgical Weight Loss Program for Teens.

Those who had the surgery averaged 190 pounds overweight. After the operation, they lost about one-third of their body weight.

Dr. Inge doesn't believe the weight loss alone explains the diabetes remission. Many of the patients, he says, were no longer diabetic almost immediately after surgery. He and others theorize that the surgery changes the way the body processes sugar.

This is only a small, pilot study; but it is already generating a heated debate over whether it makes sense to do this surgery in patients so young.

"It's a shame and a failure of our social and medical systems," says Dr. Phil Zeitler, associate professor in pediatric endocrinology at the University of Colorado, "that we have kids who are so obese that major abdominal surgery is required to cure them."

Type 2 diabetes used to be considered an adult disease, but it has increasingly become a problem in children, as has growing waistlines. It is believed to have increased tenfold in the past two decades.

Dr. David Nathan, the director of the Diabetes Center at Massachusetts General Hospital, believes there is still reason to delay the surgery in children because "there is concern regarding the effects of such surgery on growth and development."

Also, doctors say little is known about the long-term effects of this surgery.

Physicians, including the study authors, caution that gastric bypass surgery does not cure diabetes. If patients regain their weight, the diabetes can resurface.

Diabetes expert Dr. Steven Edelman a professor of medicine at the University of California, San Diego, says the surgery should be a last resort -- after patients have tried changing their lifestyle through diet and exercise. Edelman says when someone has the surgery, they are rearranging the atomic structure of the stomach and patients need to have life-long follow-up.

"This is not a small deal," he says. "This is a huge deal."

He also disagrees with study authors that the surgery somehow changes the way the body handles sugar.

"I would not bet two cents that there's anything fancy going on," he says. "You can see the same result [remission of diabetes] in those who lost the same amount of weight who don't have the surgery. "

Edelman also cautioned that this is a very small study, without long follow-up or a true control group for comparison.

All that said, the San Diego endocrinologist added the surgery is an alternative for extremely high risk children "who have failed all other medical and social interventions."

Inge agrees that this surgery is not for everyone, but says it must be considered as an option for teens who are severely obese. He says diabetes carries with it the risk of blindness, heart disease, liver disease and amputations. He says this surgery can lead to a "longer, more robust life."

That is what Munson is hoping for. She's now 19 and a college sophomore. Munson admits she still struggles with keeping off the weight. She has to watch what she eats, and how much, and take vitamins every day to ensure she's getting enough nutrients. Still, Munson believes she made the right choice for her.

"The results are that I have, finally, found who I am on the inside," she says, "and brought that person to the outside."

Copyright © 2022 WPVI-TV. All Rights Reserved.