What it’s like to have bariatric surgery as a teenager.

I was 17 when I lay on the operating table, wincing in pain as the anesthesia needle pierced the tight skin on the back of my hand. It was 2007 and the obesity epidemic was ubiquitous, which made me a dangerous statistic. The size of my body, I was told, would eventually lead me to serious illnesses, such as heart disease and diabetes, unless something was done about it. I thought this procedure would save my life.

I was first diagnosed as obese when I was 8 years old. At 10, I was on my first diet, eating low-calorie pretzels for lunch while my friends ate Oreos. When I was 14, I visited my pediatrician once a week so she could monitor my weight and lecture me on self-control. When I was 16 I was prediabetic. Two months after my 17e birthday, I had bariatric laparoscopic banding 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 consume. The procedure was only approved for adults by the Food and Drug Administration, but given the rise in childhood obesity, the FDA sought to test this surgery in adolescents in a funded study. Adolescents who were diagnosed as “morbidly obese” (with a BMI over 40) and who had tried other means of weight loss, such as diets or medications, met the criteria.

The particular surgery I had, the gastric lap band, peaked in 2008, with 35,000 surgeries performed that year. The gastric band is now rarely performed due to the high rate of complications and failure. More invasive and permanent operations, such as gastric bypass and the gastric sleeve, are more commonly used these days.

Now those invasive surgeries are officially recommended for children as young as 13 by the American Academy of Pediatrics, which recently released the first edition of a set of guidelines for treating childhood obesity. The document recommends that the families of children as young as 2 receive intensive health behavior and lifestyle treatment as a preventative measure against possible obesity, and recommends medication or surgery for older children who have failed to reduce their weight with other efforts. This 73-page report urges providers to view obesity as a chronic disease and treat it as such: with aggressive intervention.

Driving to work last week, I listened to an episode of the New York Times’ The daily to the guidelines, in which medical reporter Gina Kolata acknowledges that not every child with a high BMI will have health problems and furthermore that insurance often does not pay for less invasive options such as counseling or even semaglutides such as Wegovy. She defends the prospect of irreversible surgery this way: “There is widespread discrimination against obese people, and children and adolescents often suffer greatly. … It is a great burden for a child.”

For me, weight stigma, along with a lack of attention to my psychological well-being, was the burden. I worry about the 1 in 5 kids who meet the aggressive weight management barrier because of what aggressive weight management has done to me.

I did lose weight in the years after my surgery. And I was excited. I could finally be seen as normal, not an outcast for my problem body. But by the time I was 23, I was experiencing side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease, which are all potential side effects of the hip belt because when you have a small stomach and a narrowed opening, food and acid can have a hard time going. in the right direction through your body. It was then that I realized that the surgery that was supposed to cure my obesity problem had mishandled the underlying problem, which was a tangle of mental health and environmental challenges.

After being diagnosed with these gastrointestinal health issues, I took matters into my own hands. I wanted to know how this had happened and why I had been diagnosed with obesity in the first place. Through my research on lapband forums and Googling symptoms (“Why can’t I stop eating?”), I discovered the diagnosis of binge eating disorder, first included in the Diagnostic and Statistical Manual of Mental Disorders in 2013, half a decade after my surgery. The criteria seem to fit: eating a large amount of food in a short amount of time, eating when you’re almost full, eating when you’re not hungry. Growing up, I only briefly learned about anorexia and bulimia. It was clear that if you weren’t purging or successfully getting lean with restrictions, it wasn’t an eating disorder – you were just fat and needed to diet.

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

After this realization at the age of 23, my behavior with food changed. But not for the better. I became hypervigilant, restricting my calorie intake, exercising excessively, and purging several times a day. I didn’t want to be seen as fat anymore. I didn’t want to be an obesity statistic.

My health was deteriorating. I became severely dehydrated and orthostatic and I started vomiting blood. I knew I was sick, but at least I was thin.

I lived like this until I realized I couldn’t go on any longer. I wouldn’t survive. I needed more serious help and I went to several eating disorder treatment centers to stop the cycle and go to recovery.

Today, about 45 million Americans go on a diet each year. The diet industry makes $71 billion annually and its offerings have a dismal track record. In fact, restricting your food intake can slow down your metabolism, which can lead to weight gain. What’s more, we’ve long known about the psychological problems that intense dieting can cause: In a 1944 “starvation” study from the University of Minnesota, 36 healthy men were put on a six-month low-calorie restrictive diet. The results revealed striking physical and psychological effects on the participants: They experienced an obsession with food and exhibited disordered eating behaviors, such as guzzling water to feel full and cutting food into small bites to make it last longer. Amazingly, these psychological effects didn’t always go away; after the experiment ended, some participants binge-eated. Although I come from a stable, middle-class family, I had to deal with this suffering, which started for me with dieting in my childhood, eating “good” during the day and eating “bad” at night. My weight was a symptom of the dysfunction around me.

I wonder if doctors had ever looked beyond my body and asked me how I felt about food, my body, my family, and my life, that would have prevented me from going through undiagnosed eating disorders and ending up with a BMI that qualified me for weight loss surgery.

My fear of implementing the new guidelines – especially the surgical part of it – is not only the physical consequences such as side effects, but also the psychological consequences. Until recently, my life was defined by my weight, because I was taught from an early age that my weight defined me. My obsession with weight loss, born from early dieting, didn’t make me happier or healthier as the doctors promised me when I was 17. It caused me to have more problems to solve as an adult. The band around my stomach has loosened and it doesn’t affect my daily life. But I worry for the kids who will have permanent bariatric surgeries before they really understand their relationship with food, and self-esteem.

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