Scott Webb (Host): Welcome to “Healthy with VCU Health,” where experts from VCU Health share their knowledge, cutting-edge research, and the latest innovations to help you achieve optimal health and wellness.

I'm Scott Webb and today we're focusing on bariatric surgery for teens with Dr. David Lanning. He's a pediatric surgeon specializing in adolescent weight loss surgery. Doctor, it's so nice to have your time today. We're going to talk teen bariatric surgery, and I know in the last podcast we talked about trying to lose weight on our own. And if that doesn't work, what are our options? But that was focused more on adults. So, this time, we want to, you know, highlight the positive outcomes for teens that may be undergoing teen bariatric surgery.

So, let's start there. How long have you and your team been doing weight loss surgery on adolescent patients at Children's Hospital of Richmond at VCU?

Dr. David Lanning: Yeah. Hi, Scott. A pleasure to join you. We've been doing metabolic bariatric surgery on adolescent patients for over 10 years at the Children's Hospital Richmond successfully with great outcomes.

Host: Yeah. That's interesting. Yeah. For me, it feels like something that, you know, hasn't been 10 years, right? Like, I didn't even know. So, this is what's so great about these podcasts, is they're really educational for the host, and for listeners as well. So, like, when is a teen a good candidate for bariatric surgery?

Dr. David Lanning: it all depends. I mean, obviously, we're talking about patients that have severe obesity, so that means they're really at least 120% above the 95th percentile for their weight and have really been part of a multidisciplinary program that really tries to help the patient and the family lose weight with non-surgical support, not only from medical experts, but also dietary experts, psychology, for at least six months before we entertain the idea of surgery.

Host: Okay. Yeah, and I think that's a good point to emphasize. You know, it is a multidisciplinary team. Do lots of non-surgical things first. Surgery is a last resort if you will. And I guess I'm just wondering like what are some of the risks and potential complications from the surgery, and how likely are those things to occur?

Dr. David Lanning: Yeah. Honestly, touching on your point about last resort, I think that's historically been what some people have thought. However, you know, really we like to think of it now as a really good treatment option for many patients because we know how incredibly difficult it is for patients to lose significant weight and keep it off with non-surgical means, we support that. Some are successful, but most are not. And the reason why it's really not a last resort is that it is super effective. The vast majority of patients lose quite a bit of weight. And most importantly, the medical problems related to their weight get better, if not, go away and it's exceptionally safe. The chance of a significant complication is incredibly low. And most patients really are able to go home after one day in the hospital.

Host: That's great. Do the outcomes differ between teens and adults?

Dr. David Lanning: They actually do, whereas weight loss is as good, if you will, in adolescent patients as it is in adults, but their improvement and resolution of their comorbidities related to their weight is better in adolescent patients than adults. In other words, you know, we unfortunately now see a lot of adult, if you will, diseases such as hypertension, diabetes, even some kidney disease and so forth, in adolescent patients that we typically don't because of their obesity and their resolution is sometimes 50% better, if not more, than what we see in the adult patients. For instance, some of those I mentioned, hypertension, diabetes, the resolution rates get up well over 90% with metabolic bariatric surgery and adolescent patients.

Host: That's amazing. I wonder if you could give me and the audience just a sense of like the typical experience for teens, maybe before, during, and after surgery.

Dr. David Lanning: We meet with our patients and families a number of times to talk about surgery so they really know what to expect. We do prepare them a bit with a liquid diet, often for two weeks that's high in protein. It helps kind of shrink up their liver a little bit, make it safer. We may adjust their medications a little bit. But otherwise, they have surgery and most patients, like I mentioned before, stay just one night in the hospital. Most can go home the following day. It's done laparoscopically or, if not, robotically. So, these are small incisions. They have numbing medication that's placed there, so they don't have a lot of discomfort afterwards. They're out actually up and walking literally when they recover from the anesthesia and are back doing most activities within a few days of going home. We typically keep kids out of school for about a week or so in PE just because their incisions are a little bit sore. They can start doing other activities, dance and shooting basketball, things like that as early as a few days after surgery. And again, most get back to regular activities, even sports, in as early as a week's time.

Host: Yeah, it's really cool. Brings a smile to my face. And just want to drill down just a little bit more about the weight-related health problems that the surgery can help with, can eliminate.

Dr. David Lanning: There's unfortunately a myriad of medical problems related to people's weight when they become obese. Certainly, hypertension, diabetes, sleep apnea, polycystic ovarian syndrome, and the list is just really quite long. But fortunately, the vast majority of those are reversible, if not, really resolved with successful weight loss surgery.

And one of the things we also like to really emphasize is that these are formative years for these patients. And unfortunately, bullying and teasing is a fact, this day and age. It is very unfortunate, but a lot of these teenagers have to deal with. So, we really love to see our patients be very successful, particularly in their early teenage years. Some of our patients are 13, 14, 15. Very successful, can lose quite a bit of weight, feel better, can then be active, more active more easily, and then they head into their high school years at a weight that's closer to normal as opposed to being obese.

Host: Yeah. Feeling pretty good. Is there an age limit? I guess maybe the better way to phrase it, is there a minimum age?

Dr. David Lanning: I think that the guidance is put out by national societies and guidelines and by American Society of Metabolic and Bariatric Surgery, and even American Academy of Pediatrics. You know what all would sort of suggest there. There really are great data to support metabolic bariatric surgery in patients as young as 13. However, you know, really the standard of care would be, if they've received appropriate non-surgical support, if they are severely obese, particularly if they've got some comorbidities, that metabolic bariatric surgery would not be ruled out, if you will, based on someone's age, even if they're 12, 11 or 10. Again, it's really uncommon to operate on children that are that age. But really, standard of care would say if it's indicated, then we could proceed.

Host: Right. Not ruling it out. Sure. Just wondering, what are the next best steps, if you will, if someone is interested in getting more information about weight loss surgery for their adolescent child?

Dr. David Lanning: Well, certainly, reaching out to our clinic, we really try to only emphasize to our patients and families that we're not talking about surgery right out of the gate. We, you know, follow national guidelines that really say patients and families should get at least six months of intensive, multidisciplinary nonsurgical support before we talk about surgery. And that's certainly what we do. And often, that's sometimes even up to nine months if patients are making progress, then, you know, we can hold off. And so, what we would do is connect these patients and families with some of these multidisciplinary team members, those in Endocrinology Medicine, Psychology, dietary experts and so forth.

We do like to see the patients ahead of time to talk about surgery. Not that we plan to do it soon, but just so they're fully aware because a lot of patients and families don't really understand. They think it's an open operation. They think it's super risky. They think they'll be in the hospital a long time. They think it's painful and it's really none of the above, just so they're aware and can stay hopeful. Unfortunately, a lot of patients really struggle with losing weight when they're significantly obese, it's really hard to lose significant weight and keep it off. And sometimes patients will lose hope. But if they know that, if they keep coming to the appointments and doing as we advise, even if they don't lose significant weight, surgery may be an option for them in the future.

Host: Yeah, I had a couple teens myself. They're a little bit older now. But, as you're saying, those can be some tough years, tough classmates. And, you know, being able to help this adolescent population look better, feel better, healthier, playing sports, dancing, whatever it might be, it's all just really good stuff. Like I said, brings a smile to my face. So, thank you so much. Appreciate your time and your expertise.

Dr. David Lanning: Thank you, Scott. It was a pleasure talking to you.

Host: To schedule an appointment or learn more about teen bariatric surgery, visit the Children's Hospital of Richmond at VCU's website at chrichmond.org or call 804-828-CHOR, or 804-828-2467 if needed. And to listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is “Healthy with VCU Health.” I'm Scott Webb. Thanks for listening.