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Gastric surgery for children stirs debate

HOUSTON — One callous question turned Brittany Caesar into a medical pioneer: "Why do you eat so much? It's not normal."

At that moment, she was in the Campbell Middle School cafeteria, sitting down to her usual lunch: two cheeseburgers, two orders of fries and a Coke. She knew she weighed too much. Her whole family weighed too much. But her world revolved around food, and she could not imagine any other existence.

"Food was my best friend," she said. "It was always there for me." Somehow, her classmate's taunt, back in 2003, wounded her in a way the usual fat jokes never had. She fled to the bathroom and wept, vowing to lose weight. Her salvation did not arrive until more than a year later when, at age 14, doctors at Texas Children's Hospital performed a gastric bypass that left her stomach the size of an egg. On the day of surgery, she weighed 404 pounds.

Caesar, now 20 years old and 175 pounds, was the first teenager to undergo a gastric bypass at Texas Children's, but more quickly followed. Today, it maintains one of the busiest bariatric practices for adolescents in the country, performing one or two bypasses each month. Although the procedure is still considered experimental for children, it is fast becoming the next front in the battle against pediatric obesity.

"I honestly believe that in 5 to 10 years you'll see as many children getting weight-loss procedures as adults," said Dr. Evan Nadler, co-director of the Obesity Institute at Children's National Medical Center in Washington.

But many doctors say research has yet to establish whether immediate improvements from surgery justify altering a child's digestive system, probably for life.

"You don't really know what the outcome is," said Dr. Edward Livingston, chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center at Dallas. "You talk about the benefit being that it prevents kids from terrible chronic disease later in life. But some of them are going to regain weight. Some of them are going to have long-term complications and we won't find out until later."

No one knows exactly how many adolescents are turning to surgery to get thinner. One of the few studies, published in 2007, reported that bariatric surgery in teenagers was relatively rare but rising fast: from 2000 to 2003 (the last year examined), the number of operations tripled, to about 800.

There is little reason to think the trajectory has changed. Just last month, for example, the bariatric service at Rose Medical Center in Denver opened a program for teenagers.