Yolanda Wang, Contributing Photographer

In elementary school, Faith Anne Heeren said her peers always picked her last during field day. 

In middle school, Hereen said, a classmate followed her around and threw paper at her, calling her “a whale.” Heeren said that during a doctor’s visit, one health provider told Heeren’s mom, “just don’t feed her cookies for dinner.” 

Hereen told the News that ever since she can remember, she has consistently measured in the 99th percentile for her weight. 

Heeren’s family implemented dietary changes — she avoided foods with additives and preservatives and packed healthy snacks whenever she went to social events — but, she said, the weight never seemed to come off. 

Things reached a breaking point when she attended her brother’s science olympiad tournament, Heeren said. Sitting in the crowd, she said she felt the sides of the chairs pushing into her thighs.

 “It felt like me and my body were at war,” Heeren told the News. 

Though Heeren and her family thought they had already done everything they could, Heeren said they decided that she needed a more dramatic intervention: bariatric surgery. 

Following her surgery, Heeren founded OCEANS Lifestyles — a support group for teens who have received a gastric bypass surgery. She now advocates for teens’ right to make their own decisions and to be fully informed about their treatment options for obesity.

Bariatric surgery describes various medical procedures that help manage obesity. Sleeve gastrectomy — one of the most common types — permanently reduces the size of a patient’s stomach, restricting how much food they can eat in one sitting. The surgery also reduces the amount of hunger hormones the stomach produces. 

This January, the American Academy of Pediatrics included bariatric surgery in their clinical guidelines for treating children with obesity, which emphasized providing immediate, intensive obesity treatment shortly after a diagnosis. 

Previously the AAP advocated for a policy of “watchful waiting,” which some experts have said failed to recognize obesity as a chronic illness. The new policies state that pediatric healthcare specialists should refer adolescents 13 years of age or older with severe obesity — referring to a BMI greater than or equal to 120 percent of the 95th percentile — for evaluation for bariatric surgery. 

Surgery and recovery process

Since the AAP released the guidelines, Alan Hornick, an assistant professor of surgery in pediatrics at the Yale School of Medicine, told the News he has seen an uptick in adolescents and parents interested in bariatric surgery — especially in younger patients. 

“I think people are now more inclined to think of surgery as a kind of a first line in slightly younger patients,” Hornick said.

According to John Morton, the medical director for bariatric surgery at Yale New Haven Health System, the most common bariatric surgeries performed on adolescents is a sleeve gastrectomy.

At Yale, adolescents seeking bariatric surgery first enter the adolescent weight loss program, supervised by Michelle Van Name, an assistant professor of pediatrics in endocrinology, and her team. In this program, Van Name said, the patients undergo a comprehensive evaluation, including nutrition, psychological assessment and physical and emotional maturation. 

Van Name and her team refer the patient to bariatric surgery only if all the criteria are met and there is full family and patient support. The patient or their family can opt out of the surgery at any point during this process, she added.

“We want our patients and their families to be making an informed decision,” Van Name told the News. “It’s also important for them to know what medications are currently approved to treat the disease of obesity, and make sure everybody has up to date information so that they can decide if this is the right time in this adolescent’s life for them to follow this treatment path.”

After the initial evaluation, Morton and Hornick conducted further observation, typically meeting with the patient six times before the surgery to offer habit-change encouragement and ensure rigorous preparation, Morton told the News. 

According to Morton, he will choose not to perform the surgery if the patient has an active substance abuse or an untreated mental illness, or if the family is not willing to implement lasting changes in the household.

“Otherwise, it’s a very difficult problem,” Morton said. “It would be like sending home an asthmatic child to smokers.”

Morton said that before the surgery some patients are prescribed weight-loss drugs, such as Wegovy or Mounjaro, to lower the patient’s weight before surgery. Two weeks before surgery, patients adhere to a liquid diet, which he said helps shrink the patient’s liver and kick starts weight loss in the patient.

According to Morton, the procedure takes roughly 45 minutes. He said that he makes four incisions, each less than three-quarters of an inch. Morton said that he then takes the stomach —  roughly the size of a football — and uses a surgical stapler to remove two-thirds of the stomach, leaving it about the size of a banana.

“The portion of the stomach we removed is not essential for digestion,” Morton said. “Its main role is to allow us to eat more. That rendered an evolutionary advantage to us many years ago, when we weren’t sure where our next meal was coming from. Now with all the food availability, we don’t need it.”

After the surgery, patients recover in the hospital for one or two days, he said. 

Then, according to Morton, they are put on a gradual diet escalation. For two weeks, he said, the patients only consume liquids and go on a puréed diet for a couple of weeks. Morton said that once patients return to regular eating, physicians recommend that they exercise and consume more protein and fewer carbohydrates and sugars.

“Once they are discharged from the hospital, we talk to them nearly daily, once they are discharged from the hospital, and then we see them monthly,” Van Name said. “Adolescents tend to need support.” 

According to the AAP guidelines, bariatric surgery can result in weight loss and improvements in multiple conditions associated with obesity, such as hypertension, Type 2 Diabetes and cardiovascular disease.

Morton said he has also conducted a study that found that the surgery produces a “halo effect,” where family members tend to lose weight when a patient undergoes the surgery.

Weight loss, transformations, and criticisms

Heeren said the surgery transformed her relationship with her body. 

“Afterwards, I finally was able to live my life in a healthy way and have my body be able to go on runs and be able to play tennis,” Heeren said. “It felt like we were a little bit more at peace.”

Heeren said that she had to overcome several hurdles during her surgery journey. She said that had to miss school days, and her mother had to miss work so she could attend pre-operative visits that took up multiple hours.

Heeren said that some people in her community criticized her parents for allowing her to have the surgery.

“There’s a lot of people who thought that [my parents] were doing something that was going to be putting me in danger instead of helping me,” Heeren said. “A lot of times, people criticize parents of kids living with obesity and blame them for why their children are struggling. My parents had it coming from a bunch of different directions growing up.”

Many patients also struggle to receive insurance coverage for bariatric surgery, forcing patients to pay for the surgery out of pocket, which limits access to the surgery. 

Balancing benefits and concerns 

Potential complications that come with the surgery include bleeding, infection, reflux for sleeve procedures, blood clots and nutritional deficiencies, according to Morton. Yet, he said the surgery is as safe as a knee or hip replacement.

“I’ve had the good fortune of, over the last 22 years, not having any operative mortality, and that’s been over 6,000 cases,” Morton told the News.

Despite the relatively safe track record for bariatric surgery that Morton described, some people have criticized the AAP for including it in their guidelines. After they first released the guidelines, both the New York Times and Mental Health America published opinion articles that expressed concern about the surgery. 

Mona Sharifi, an associate professor of pediatrics and biostatistics at the Yale School of Medicine, helped write the AAP’s guidelines. According to Sharifi, to produce the guidelines, a team of clinicians sifted through thousands of scientific articles and generated a summary of the results, which they translated into policy. 

Sharifi said she felt that some of the initial criticisms focused too much on the medication and surgery recommendations, failing to recognize that the AAP also promoted various weight treatments within the context of a family’s preferences and options.

“We very carefully placed the recommendation on making a referral or connecting families with a program — not that surgery should be done,” said Sharifi. “They don’t necessarily mean that when you’re referred, you’re gonna have bariatric surgery.”

About 2,000 adolescents receive gastric bypass surgeries every year in the United States.

Carlos Salcerio covers the Yale School of Medicine and the Yale School of Nursing for the SciTech desk. Originally from Cuba, he is a prospective pre-medical student majoring in Molecular Biophysics and Biochemistry in Jonathan Edwards College.