Not the easy way out

By James D. Geiger, MD

Childhood obesity is such a serious issue that First Lady Michelle Obama launched her Let’s Move campaign. While the campaign is doing a great job of drawing attention to the issue and encouraging children and teenagers to be more active, for many severely obese adolescents, getting up and moving is not the only answer. But, is weight-loss surgery the right answer?

Here at the University of Michigan C.S. Mott Children’s Hospital Pediatric Comprehensive Weight Management Center, we’ve always taken a comprehensive approach to treating childhood obesity. Our MPOWER (Michigan Pediatric Outpatient Weight Evaluation & Reduction) program brings together a team of healthcare providers (physicians, dietitian, psychologist, social worker, exercise physiologist and physician assistant) to evaluate and treat obese adolescents.

For some patients, treatment includes weight-loss surgery, but that’s not the easy way out. To be truly effective, weight-loss surgery has to be part of an overall change in lifestyle. Weight-loss surgery is not the first line of treatment. All of our patients and their families, surgical and non-surgical, participate in the MPOWER program to help them learn healthy life habits.

Every patient in the MPOWER program meets with a Registered Dietitian to help him or her learn about making healthy food choices. The dietitian also meets with the family to help ensure the child has family support and that the family has the nutritional knowledge necessary to help guide the child.

The MPOWER team also helps the child and family embrace the lifestyle changes needed for the child to lose weight. Regular visits to a therapist by both the patient and the family help keep everyone on track.

And, of course, there’s a fitness component. Each patient participates in group exercise classes and learns the benefit of adding more physical activity into their everyday life.

For some patients, those components of the MPOWER program are enough to help them reach an ideal body weight. Others need the assistance of weight-loss surgery. That’s what makes our program so unique. It’s not an either or approach. It’s a comprehensive approach. Our team meets regularly to review the records of those patients who have expressed an interest in weight-loss surgery.

We look to see if the patient and his or her family are embracing the nutritional, behavioral and physical activity tenets of the MPOWER program. We don’t want to see patients fail, so if they aren’t embracing those lifestyle changes, they are not candidates for surgery. If a patient and his or her family has shown dedication to eating healthier foods, controlling portions, increasing activity level and embracing the other behavioral changes recommended during the program, we will consider him or her for surgery.

In addition to the commitment to lifestyle changes, adolescents need to have a body mass index (BMI) of more than 40 to be considered for surgery. They also must have finished growing. For girls that typically means 13 or 14 and for boys that’s typically 14 or 15, but we evaluate each child’s growth as part of the process to determine if weight-loss surgery is an option.

If we determine weight-loss surgery is a good option for a particular patient, we’ll explain the different surgical procedures to the patient and his or her family. For adolescents, we offer gastric bypass and the gastric sleeve. Both surgeries limit the intake of food by creating a smaller stomach pouch. Each procedure has its advantages and disadvantages, which are clearly explained to all patients and their families.

Just as we don’t just jump into surgery, we don’t just perform the surgery and push patients out the door to face the world after surgery. Our comprehensive program continues to work with the patient. This is a really important part of the process. Without post-surgical counseling and education, the risks of negating the positive effects of the surgery increase.

We work with patients and their families to help them adapt to their new eating habits. They see the same MPOWER team members they saw before surgery to help them make good nutritional choices and keep active. We encourage our surgical patients to interact with each other through our programs and via social media platforms. Having that support group of peers really helps with their transition and success.

Weight-loss surgery certainly isn’t for every obese adolescent, but for those who are willing to work hard and follow a new lifestyle, it’s certainly a wonderful treatment tool for us to have available. Given the risks of a lifetime of obesity, we’re happy to help these children in whatever way makes sense for them individually.


Talk with our experts LIVE online – Wednesday, May 11, 12 noon to 1:00 pm

Dr. Geiger will join Dr. Susan Woolford and Dr. Joyce Lee in a live webchat to answer all your questions about weight management for kids and teens, including tips on establishing healthy habits, a healthy diet and introducing exercise into your family’s routine.  Register for free at www.metroparent.com/mottwebchats



Dr. James Geiger is a pediatric surgeon at C.S. Mott Children’s Hospital.  Dr. Geiger also sees patients at St. Vincent Mercy Medical Center in Toledo and is the Executive Director of the University of Michigan Medical Innovation Center.