What does bariatric surgery look like in a teen?

I was 17 when I lay on the operating table, in excruciating pain as the anesthetic needle pierced the taut skin on the back of my hand. It was 2007, and the obesity epidemic was raging everywhere, making me a serious statistic. I was told that my body size would eventually lead to severe disease, such as heart disease and diabetes, unless something was done about it. I thought this procedure would save my life.

I was first diagnosed with obesity when I was eight years old. By 10, I was on my first diet, eating low-calorie pretzels for lunch while my friends ate Oreos. By the age of 14, I was visiting my pediatrician once a week so she could track my weight and give me a lecture on self-control. By the age of 16, I had prediabetes. Two months later I’m 17^y Birthday, I got laparoscopic bariatric ligation surgery: A reversible, inflatable device was placed around the upper part of my stomach, creating a smaller “pouch” and limiting the amount of food I could eat. The procedure is only approved by the Food and Drug Administration for adults, but due to the high rates of obesity among children, the FDA sought to test this surgery among adolescents in a funded study. Adolescents diagnosed as “pathologically obese” (with a BMI over 40) who had tried other means of weight loss, such as diet or medication, met the criteria.

My specific surgery, the gastric band, peaked in 2008, with 35,000 surgeries performed that year. Gastric banding is now rarely performed due to the high rates of complications and failure. Today, more invasive and permanent surgeries are used, such as gastric bypass and sleeve gastrectomy.

Now these invasive surgeries are officially recommended for children under the age of 13 by the American Academy of Pediatrics, which recently released the first edition of a set of guidelines for treating childhood obesity. The document states that families of children under two years of age receive intensive healthy behavior and lifestyle therapy as a preventive measure against possible obesity, and recommends medication or surgery for older children who have not been able to lose weight with other efforts. This 73-page report urges caregivers to view obesity as a chronic disease and treat it as such: through aggressive intervention.

On my drive to work last week, I listened to an episode of The New York Times newspaper According to the guidelines, medical reporter Gina Kolata acknowledges that not every child with a high BMI will have health problems, and furthermore, insurance often won’t pay for less invasive options like counseling or even semaglutides like Wegovy. She defends the possibility of irreversible surgery in this way: “There is widespread discrimination against people with obesity, and children and adolescents often suffer severely. … It’s a huge burden for a child.”

For me, the weight stigma, along with a lack of concern for my psychological well-being, was the burden. I worry about one in five children who meet the threshold for aggressive weight treatment, because of what aggressive weight treatment has done to me.

In the years following the surgery, I lost weight. And I was overjoyed. I can finally be seen as normal, not ostracized because of my physical problem. But by the time I turned 23, I started experiencing side effects from the surgery, such as frequent vomiting, heartburn, and the inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease, all possible side effects of a lap band, because when you have a small stomach and a narrow opening, food and acid can have a hard time going the right way through your body. I realized then that the surgery that was supposed to fix my obesity problem didn’t do a good job of addressing the underlying problem, which included a tangle of mental health and environmental challenges.

After I was diagnosed with these gastrointestinal health issues, I took matters into my own hands. I wanted to know how it happened and why I was diagnosed with obesity in the first place. Through my research on rhythm forums and referencing my symptoms (“Why can’t I stop eating?”), I discovered the diagnosis of binge eating disorder, which was first incorporated into Diagnostic and Statistical Manual of Mental Disorders In 2013, half a decade after the surgery. The criteria seem to fit: eating a large amount of food in a short period of time, eating past the point of satiety, and eating when you are not hungry. Growing up, I only briefly learned about anorexia and bulimia. It was clear that if you weren’t successfully binging or getting thin with the restriction, it wasn’t an eating disorder – you were just fat and needed to diet.

I started therapy and opened past wounds that I had tried to ignore. My disordered behavior with food developed as a coping skill to deal with my dysfunctional family environment and an undiagnosed anxiety disorder, and eventually developed into a mental illness. But in all my visits to doctors, nutritionists, and diet coaches, no one has ever asked me what’s wrong with my family, my mind, or the culture around me.

After this realization at 23, my behavior with food changed. But not for the better. I became hyper-vigilant, restricted calorie intake, over-exercised, and cleansed several times a day. I don’t want to look fat anymore. I didn’t want to become an obese statistic.

My health took a turn for the worse. I became severely dehydrated and haemorrhagic, and began vomiting blood. I knew I was sick, but at least I was thin.

I lived like this, until I realized that I could no longer. I will not survive. I needed more serious help, and went to several eating disorder treatment centers to stop the cycle and move toward recovery.

Today, about 45 million Americans go on a diet each year. The diet industry makes $71 billion a year, and its offerings have a great track record—in fact, restricting your food intake can slow your metabolism, which can lead to weight gain. What’s more, we’ve known for a long time about the psychological distress that intense dieting can cause: In a 1944 University of Minnesota “Hunger” study, 36 healthy men were put on a reduced-calorie diet for six months. The results revealed surprising physical and psychological effects on the participants: They experienced food obsessions and displayed disordered eating behaviours, such as drinking water to feel full and cutting food into small bites to make it last longer. Surprisingly, these psychological effects did not always go away; After the experiment ended, some of the participants found themselves binge eating. Although I come from a stable, middle-class family, I linked this distress that began for me to dieting in my childhood, eating “good” foods during the day and then gorging on “bad” foods at night. My weight was a symptom of the dysfunction around me.

I wonder if doctors looking at my body and asking me how I feel about food, my body, my family, and my life, that would have prevented me from going through an undiagnosed eating disorder and ending up with a BMI that qualifies me for weight-loss surgery.

My fear of applying the new guidelines—especially the surgical part of them—is not just the physical consequences as side effects, but the psychological consequences. Until recently, my life was defined by my weight, because I learned from an early age that it was my weight that defined me. My obsession with losing weight, triggered by early dieting, has not led me to be happier or healthier, as doctors promised me at the age of 17. The belt loosens around my stomach, and it does not affect my daily life. But I worry about children who will undergo permanent bariatric surgeries before they truly understand their relationship to food, and Self value.