Eric DECKER knew at age 5 that he had a weight problem. "I was so much bigger than anyone else," he recalled. "I could never wear children's clothes as a kid."
By age 10, Decker had seen dozens of doctors and nutritionists about his condition and was regularly attending meetings of Weight Watchers. A middle-school counselor once took him aside and advised: "Lose weight or grow a thick skin."
He did lose weight but usually gained it back -- and then some. By age 17, Decker stood 5 feet 9 and weighed 385 pounds. He had a hormonal disorder, back and knee strain, and was at high risk of developing heart disease and diabetes, according to his doctors.
That's when the South Carolina teen turned to bariatric surgery, an operation to reduce the size of his stomach and severely limit the amount of food he could ingest. The surgery took place 20 months ago at Cincinnati Children's Hospital Medical Center. Today, Decker carries just 185 pounds on his 5-foot-10 frame.
"At first my mom was really apprehensive about my having this surgery," said Decker, 19, who became interested in the procedure after he saw actress-singer Carnie Wilson talk about her experience with bariatric surgery on television. "But this was a last resort. I had tried everything. Doctors had told me I had to lose weight because it would eventually kill me."
Bariatric surgery, once considered a drastic alternative for obese adults, is gaining acceptance among doctors who treat severely obese children, though it remains controversial in some medical circles. Although no one tracks the precise number of children and teens who have undergone the surgery, the number is thought to be small. Many surgeons who perform the procedure on adults now have patients who are children, and several pediatric medical centers nationwide, including one at Stanford University, are launching bariatric programs.
An estimated 140,000 American adults will undergo weight-loss surgery this year -- up from 75,000 last year. Ten years ago, the procedure was fairly uncommon in adults, and it's growing popularity reflects a sobering reality: More Americans than ever before are severely -- or morbidly -- overweight. (Morbid obesity is usually defined as having a body mass index greater than 40; a score greater than 30 is considered obese.)
"If you look at the prevalence of morbid obesity, it's twice as dramatic an increase as obesity alone," says Dr. Thomas Harris Inge, a pediatrician who has performed the bariatric procedure on 42 adolescents since founding the child bariatric surgery center at Cincinnati Children's Hospital two years ago.
Morbid obesity has risen rapidly in children and teenagers too. An estimated 127,000 to 255,000 teenagers have a body mass index of 40 or greater, Inge says.
Bariatric surgery reduces the stomach from about the size of a football to the size of an egg. If patients don't adhere to permanent changes in their eating habits they will suffer from pain, diarrhea and vomiting. For example, sugar, high-fat foods and carbonated beverages should be avoided. Total calories are typically limited to 1,000 to 1,200 per day -- about a cup and a half of high-protein food. Vitamin and mineral supplements have to be taken every day to replace nutrients that no longer can be absorbed in the intestine.
And these changes must persist for the patient's lifetime to maintain the weight loss.
It's a tall order for someone who hasn't yet graduated from high school. And bariatric surgery in children is certainly controversial.
"Children's nutritional needs are different than adults'," says Jeannie Moloo, a registered dietitian in Sacramento and a spokeswoman for the American Dietetic Assn. who works with adult bariatric surgery patients. "The surgery itself isn't just shrinking the stomach size. Some of it is to bypass some of the absorption area of the intestine, and there is the potential for malnutrition. I strongly urge that parents try to pursue every other option available prior to surgery. But for some severely overweight children it may be the best option they have."
According to Inge, some severely obese children develop such serious health problems that surgery is considered lifesaving. Inge spoke about his program earlier this month at the annual meeting of the American Dietetic Assn. in Anaheim.
"We're not talking about cosmetic surgery here," he says. "Severely obese adolescents are developing adult diseases."
Many of his young patients, for example, have sleep apnea, liver disease, enlarged hearts and Type 2 diabetes. Studies show that, without significant weight loss, such children are at high risk for heart disease and osteoarthritis. They are also 10 times more likely to develop colon cancer than their normal-weight counterparts.
