Natalie Moore has lost more than 100 pounds since May 18. That's when Natalie, 17, underwent gastric bypass surgery at Children's Hospital Medical Center. It's the same procedure that singer Carnie Wilson made famous when fans watched via the Internet as her stomach was surgically shrunk.

Natalie Moore has dropped from a size 36 to size 16. (Eric Thomas photo) | ZOOM |

        Natalie, however, is the first patient to receive the surgery under a new comprehensive weight management program at Children's and the second overall to choose a drastic weight-loss option that requires a lifetime of maintenance. Getting back and forth from her home in Yoder, Ind., to follow-up appointments at Children's means a five-hour drive one way. The procedure is so intense that some states don't allow anyone under 18 to undergo it.

        Natalie says it's worth it.

        “I feel a lot better,” she says. “I have more energy.” She had tried more conventional approaches — counting calories, exercising, even diet pills — but they didn't work.

INFOGRAPHIC

What stomach bypass is

        But experts — including the surgeons who worked on Natalie — warn that the surgery isn't a good fit for every teen-ager. Gastric bypass surgery is considered a last resort for people who need to lose a lot of weight, but the physical and emotional changes it brings make it a high-maintenance option for teen patients.

        Natalie underwent a Roux-en-Y gastric bypass procedure. The top portion of her stomach was stapled to create a small pouch, restricting the amount of food her stomach can hold.

        Then a Y-shaped section of her small intestine was attached to the pouch, allowing food to bypass the top portions of her small intestine (the duodenum and jejunum), reducing the amount of calories and nutrients her body can absorb.

        The procedure is straightforward, but it's not without risk.

        There's always the possibility of infection. Natalie had to have surgery in October to correct scar tissue that had formed and was blocking the bypass. For several weeks after the surgery, she could only eat liquid or soft foods.

        She can't eat sweets anymore — her body can't absorb the sugars properly — and she can only eat about 2 ounces of food at a time. There's a risk of malnutrition, because her body might not absorb enough B12, iron and calcium from the food she eats.

        She and her family had to undergo psychological screenings to check for eating disorders and other problem behaviors before she could have the surgery, and they've had to learn about proper nutrition. She attends a support group for teens who've had gastric bypass surgery.

        And there's no guarantee the surgery will work for the long-term.

        People who undergo gastric bypass surgery lose about two-thirds of their excess weight in the first two years, but the weight can come back if patients don't count calories and exercise regularly.

        The surgery can restrict the amount of food a person can eat at a single sitting, experts say. But it can't control the other factors — physical, emotional and psychological — that make obesity a deadly disease.

        Sometimes people overeat when they're unhappy or stressed, so Natalie's learning a new approach. “Before when I was having a bad day, I'd go and eat,” she says, “now I can't.” She goes for a walk instead.

Not for any teen

        Before the surgery, Natalie weighed 298 pounds. At 5-foot-4, that put her body mass index at 51, which is considered morbidly obese.

        “This is a child who only cried when she was hungry,” says her mother, Kitty. Natalie has always been heavy. When she was in kindergarten, she weighed 95 pounds.

        For Natalie, her excess weight meant high blood pressure, severe acid reflux, sleep apnea, back pain, incontinence and ovarian cysts. She was constantly spraining her ankles and knees just walking. Not losing the weight would put her at risk for Type 2 diabetes, heart disease, some cancers and musculoskeletal problems like osteoarthritis as she got older.

        Natalie's health problems matched the standards most bariatric surgeons set for gastric bypass surgery. The procedure isn't an option for anyone, adult or teen-ager, who just needs to drop a few pounds quickly, says Dr. Kenneth MacDonald, chief of gastrointestinal surgery at the Brody School of Medicine at East Carolina University in Greenville, N.C.

        Dr. MacDonald says he has particular concerns about performing the procedure on teens.

        “The negative aspects involve questions about maturity and ability to understand risks and possible mortality — will they be compliant with diet and exercise instructions, etc.,” he says. “Also will the relative malnutrition affect growth, intellect, bones, etc. On the positive side, surgery and weight loss may greatly help the patient's psychosocial development, which likely is severely affected by being morbidly obese at that age.”

        But Dr. MacDonald and other experts agree there's a key question that has to be answered in choosing teen candidates for gastric bypass surgery: Are the risks posed by the teen's weight problem greater than the risks posed by the surgery itself?

        If the answer is yes, say Dr. Victor Garcia and Dr. Tom Inge, the surgeons at Children's who worked on Natalie, then the teen is a good candidate for the procedure.

        The surgery is a last resort, but it's still just the beginning of what patients have to do to get their weight under control, Dr. Garcia says. The new program at Children's incorporates psychological and behavioral therapy to teach young patients how to have a healthy relationship with food.

        And it's rare for a teen-ager to get the surgery: At a recent meeting of the American Society for Bariatric Surgery, there were more than 100 displays on bariatric, or weight-loss surgery, Dr. Garcia says. Only two of them addressed adolescent patients.

        Since the surgery, Natalie's blood pressure is down. Her back has stopped hurting. The cramps caused by the ovarian cysts have stopped. And Natalie's happier.

        “I feel a lot better about myself,” she says. “A lot more self-confident.”

Peer pressure

        Natalie's been heavy all her life, but those pounds didn't seem to matter as much until her health problems got so bad, and she got to high school. In middle school, she was a cheerleader and served in student council.

        In high school, her health worsened and she couldn't be as active as she wanted.

        Natalie is among the 14 percent of American adolescents who are overweight, according to the Centers for Disease Control and Prevention.

        But even as Americans in general get heavier, there's an incredible amount of pressure on teens to be thin. That pressure can take its toll on teen-agers who are too large to fit the popular mold, says Dr. Ann Kearney-Cooke, the director of the Cincinnati Psychotherapy Institute in Montgomery.

        “Popularity in high school is very much based on how you look and often how athletic you are,” Dr. Kearney-Cooke says. “There's a real charge around the body.”

        For some teens, that pressure results in abusing diet pills and laxatives in an effort to stay thin. For some, it leads to eating disorders like bulimia and anorexia nervosa.

        Natalie didn't go to that extreme, but asked if she tried any popular diets, and her response was, “Which one?”

        She tried SlimFast and Dexatrim. She tried fen-phen before it was pulled off the market. She tried sticking to a 1,500-calorie a day diet, but after a year and a half, she'd only lost 15 pounds.

        Dr. Kearney-Cooke, like most experts, thinks gastric bypass surgery should be a last resort for obese teens, and prospective patients should be screened carefully for eating disorders and other problems before they get the procedure. Gastric bypass surgery can make pounds disappear, but it can't fix the reasons people overeat and fail to exercise.

        And, even for people who are desperately unhappy about their extra pounds, there's kind of a Catch-22 when they lose a lot of weight, Dr. Kearney-Cooke says. For teen-agers, especially, learning to deal with a new body image and different reactions from peers can be very difficult.

        “I would imagine they're going to feel really happy, but I've seen with adults that there are often ambivalent feelings, and the one that always stands out to me is, "I'm the same woman I was before I lost the weight, so why are you asking me out now?' ”

        Natalie's already getting that reaction. Since the surgery, she's gone on her first date. And boys are buzzing around, says her father, Rick.

        That's a plus, Natalie says. “Before I never talked to guys,” she says. “Now I talk to guys all the time.”

        But she's also noticed classmates who never gave her the time of day before the surgery are inviting her to parties and the movies now that the pounds are dropping off.

        “I basically tell them, "If you didn't like me before, don't come around now,”' she says.

Making changes

        As the pounds continue to drop off, Natalie's learning a new way of eating that she'll have to keep up for a lifetime. She keeps a food diary to track her portions every day. She's learning to exercise. And since she can only eat about two ounces of food at a time, there's no point in ordering a super-sized combo meal. A few bites of chicken and vegetables fill her up quickly.

        For the first time in her life, Natalie says, she knows what it's like to feel full.

        Most telling is her new favorite color: pink. After a lifetime of favoring blue, she's redecorated her bedroom and refurbished her wardrobe in the ultimate girl-y color.

        “I read where that means you're happy with yourself,” Kitty Moore says, like the proud mother she is.

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