Would you allow DD to have bariatric surgery?

[Stephens90]

Hi,

DD is 17 and has recently been referred, with the intent of having a gastric bypass. She has a BMI of almost 60.

This isn't a post to figure out why I let her get that size. She gained 10 stone in the last 6 years since she joined secondary. My other children are not overweight.

She has recently been diagnosed with PCOS.

I've tried to support her with weight loss for a very very long time. She did slimming world last year but couldn't keep the weight off. Followed the NHS weight loss plan, calorie counted, etc.

She has bad depression and it seems everything is such a vicious cycle, I'm worried I will lose her if I don't support her down the surgery route. She is breathless after getting up and walking to the bathroom and honestly it scares me I'll wake up without her.

On the other hand, she is so so young and I feel it's such a life changing decision at just 17, but I do trust the consultants who have said to me she simply won't have a life if it continues and they believe surgery is the best thing.

I'm just so unsure and want to ask from other parents perspective instead of from health professionals.

Thank you

Does she lack capacity to consent for herself? I don’t think you get to allow or disallow anything at her age. Sorry if that sounds mean. You sound like a very caring Mum abs want what’s best for her. What does she want?

It sounds like she definitely needs support with her mental health as well as any physical medcial intervention. With a BMI of 60 I would strongly consider surgery, and they won't have offered it lightly. When does she turn 18, is it soon?

A 17 year old with a BMI of 60 either has an underlying medical disorder or an unaddressed mental health issue. Gastric bypass alone won’t solve her weight problem. It only works if people follow the diet afterwards.

Your daughter clearly has psychological reasons contributing to her binge eating and obesity. Surgery won't fix that.

That said however, following the bariatric surgery pathway is generally the way to get specific psychological therapies for eating disorders like this, so going through the process may not be such a bad thing - it may not go as far as surgery.

My concern would be that she has the surgery which is irreversible, but doesn't address the psychological issues and ends up no further forwards with her weight and health.

My own personal experience is that I lost 14 stone when I was 26, 50% of my bodyweight, after battling for years. In order to do that, I had to get my depression and anxiety under control and after that it was actually remarkably easy, as that need to overeat and binge eat wasn't there any more.

I forgot to say, have a look at Obesity UK (or I think they go by HOOP) on Facebook. They also have a specific bariatric surgery group as well.

Has she tried Vyvanse? I take it for ADHD, but it unexpectedly dealt with my binge eating issues overnight. Asked my doc about it and this is another function it serves. A lot of overeaters have ADHD, and it's about searching for a dopamine hit. I would have had a very different life if this had been realised earlier.

I did a liquid only diet for 3 months with medical supervision in my 20s, and that allowed me the space to do some CBT around food and impulse control. I lost 6 stone and regained 10 over the next 5 years. Then I ate a very restricted keto diet for a good 5 years, which helped drop the weight, but I needed significant surgery to remove excess skin. In the end, medication has been the answer, because I simply cannot keep fighting this forever. With my brain stimulated, I don't seek the reward of eating. Without this, I get day dreamy, and can't say no to the opportunity to feel stimulated by sugar. It's truly an addiction, but nobody can go cold turkey forever on food, so I feel like an alcoholic who is allowed 3 sips of wine a day, trying desperately not to relapse.

Before the surgical route, I'd want to know I'd tried the pharmaceutical options. The only thing to bear in mind is that it does elevate heartrate and with a BMI of 60, her heart will already be struggling.

I wouldn't dismiss the surgical option. It is a big deal, but so is a life time feeling trapped by your actions and body. I really feel for your DD. I never reached that size but I so easily could have. I'm nearly 40 now and retraining as a psychologist. If I hadn't found a way to regulate my dopamine with a pharmaceutical option, I have no doubt that I would be fighting yet another battle with weight gain after the last 'solution' stopped working for me.

As pp’s have said she has to be in the right place mentally , surgery is only half the solution the other half is being committed to eating properly afterwards.
My bil had a gastric bypass but has put all the weight back on due to his eating habits.

Whilst supporting the surgery seems like the right thing to do- it's not going to actually change anything, that he to come from her. You eat round gastric surgery- takes a while but is very possible. The depression isn't going to go with the weight- does she have good ongoing mental health support, along with long term dietician support? So often the support post surgery is poor, not long term, and doesn't really adress the initial cause. It's a horrible cycle- I really do wish you both the best.

Thank you very much! Sorry I fell asleep.

With the mental health issues I think it's a massive no.

I am close to someone that had it - they really were not given enough counselling prior. What we didn't realise was how much their eating was a product of the mental health.

With that gone they turned to serious self harm. It escalated all the MH issues and they have since been sectioned many times and tbh I just wait for the call to say it's gone too far.

Also ended up malnourished as for the small amount they could eat they chose to eat crap - the bypass stops you absorbing nutrients.

Knowing she has existing MH issues you need to focus on resolving them - if that's done the weight may well sort itself out.

You say she’s on antidepressants - I hope not mirtazapine?

Good yes. I know 2 people who have had it. Fabulous.

To add to what other posters have said, you need to also prepare her for being turned down for surgery, the surgeon may feel she is not mentally ready. It may not happen but it is sensible to not pin all hopes on surgery to then have it dashed.

When they both came out from hospital they had to go back to baby food, then could barely eat more than a tiny portion. Their whole relationship with good changed and they fancied eating nothing.

In the sessions pre surgery this was discussed. But no one and I mean no one 'gets it' or comprehends the enormity of it, I don't think, until you experience it.

Something that restricts how much she can eat I guess would be ok but surgery that actually removed part of her stomach etc no way. She is highly unlikely to instantly change the way she’s eating and could seriously harm herself. The rest of her life is a very long time to never be able to eat a proper meal and she just doesn’t sound like she’s going to be able to stick to the rules.

I don’t know what I’d suggest as an alternative, I’m sorry, but it sounds as though she’s looking for something that requires no will power or control on her part and surgery just isn’t that. In the past I’ve read about people getting their jaws wired for exactly this reason, is that sort of thing even available now. I mean who buys a pizza in the night knowing they’ve got to purée it and drink it through a straw...

Hi I started a thread nearly a year ago- contemplating bariatric surgery. We’re probably a fair bit older than your dd but might be worth a read- a lot of posters (including myself) have since had the surgery and it might answer some questions

I paid for my niece to have a gastric sleeve a few years ago at 23 she was 25 stone
She is now 11stone and has kept the weight off . She is a different person
Because she was young she has very very little loose skin
The older you get the more loose skin you get so younger is better
One thing that can work although at the moment it’s only available for diabetes Is Ozempic (Semaglutide)
It’s not yet licenced for weight loss but my cousin lost 7 stone on it last year and has kept it off
So if she has diabetes which is very possible at her weight it’s an option
When my cousin was taking it she said there was no urge to eat at all
With gastric sleave surgery the sweet point is 18 months - 2years after that you can put the weight back on
So if you haven’t dealt with the reason you overate you will probably start to put it back on
Also you need to take liquid version of vitamins as you won’t absorb regular tablet ones
This is very important as you can end up deficient of b12 & Iron

Firstly if she is seriously depressed she’s probably not in the right frame of kind to make such a huge decision is she?

Secondly, has she tried a ketogenic diet? It cures my PCOS and completely eradicated your appetite because your blood sugar becomes so stable

I bet she’d love not having to think about food so much. It’s a relief when the weight starts to come off.

Finally. She would still need counselling to overcome the urge to overeat - surely?

One thing that can work although at the moment it’s only available for diabetes Is Ozempic (Semaglutide)

I was watching some videos on this drug and it's really interesting as an alternative to surgery. It helps to control the appetite but in a much safer way than any of the appetite suppressants we have at present as it was originally developed to treat diabetes and it's something you can take long term if needed.
As your DD is 17 it should be very much her decision but I think with the irreversible nature of the surgery and the health risks I would want to look at these new drugs and see if your medical team will consider them.

Just to add..

Is her weight still increasing? The heavier she is the more risks to the surgery...

Unless her weight is reducing or at least stable I would do it sooner rather than later. A couple of years and a few more stone down the line and it may be medically to risky.

Hello I had a gastric sleeve when I was in my early 30s. I was at a different stage in my life. I also have PCOS which has not been cured by this so weight gain is still an issue but 1 and a half stone is much easier to deal with than ten!

Many areas have bariatric support groups you can visit probably by zoom now where there are a mix of people including pre post and years after op all sharing experiences. There is usually a mix of ages there so there could be someone that is a similar age to your daughter.

Unfortunately the surgery does not perform magic and you have to prove you can manage the process and do the work. Look at the food you have in your house and maybe have a clean out. Try to start some sort of exercise even if it is just a walk around the block three times a day to start. I know this will be difficult and there will be tough days.

As a family join my fitness pal and log everything. Even if you are. It completely honest it does open your eyes.

Also consider a savings account where you deposit £1 for every pound lost and more for each stone with an agreed reward at the end of it all. With the PCOS maybe laser hair removal might help. I know that PCOS really changes how you feel about yourself and the added weight doesn't help so look at self care and small steps.

I lost ten stone and have put back on a stone and a half which I am now addressing. But I also did two half marathons and two night marathons which I never could have done pre op. I wish her well. It's a difficult journey but will be worth it.

I think at 17 it is her decision really unless she lacks capacity. Nothing wrong with you talking to her about your worries and looking at other options bit if she is being referred and the medics think it is right for her she will have to make a decision, hopefully psychological support will run along side.

Yes I would

Gosh that's tough. I think you need to push very hard to make sure there's no medical or hormonal issue. If your GP isn't supportive, change to another.

Sorry to say this but it's something to be aware of - sometimes weight gain can be a way of dealing with sexual abuse or assault. It can be a way to subconsciously make yourself non-sexual.

Thank you so much. Will definitely have a chat with her about everything that has been said. Mixed messages from all the professionals doesn't make this easier. One GP said she should maybe try orlistat (not sure if that's how it's spelt) where as another GP said that's it's not very effective with her BMI.

I feel sad for her because every day since she was around 11 has been about her trying a diet, I don't think there has been a day she hasn't woken up and planned to diet, so it's not that she doesn't want to do it, she just "messes up" on a binge at night. I can just hope no matter what happens she will one day be healthy and happy. At the moment I just can't see it unless something changes and I agree about the mental health but how does that get fixed? She has always cooperated with professionals but it seems to get worse with the weight and the weight gets worse with the mental health and the only answer we seem to now have at this point is the surgery.

She hasn't tried Keto before.

Her mind seems to always be on food, self harm or suicide and I'm just so lost.

She is continuing to gain weight rather rapidly, 4 stone in the last 12 months. Which is so disheartening when she feels she is constantly attempting a diet. But blows it because she will consume 4K calories in a binge. We try ways to cope before a binge and I tell her she can wake me up or anything and I'll try to help and she tells me she can't do that so I don't know how to help anymore :(

I feel like a very failed parent especially when most of my friends judge it and people judge her. My 2 other children (a couple years younger) are fit and healthy with normal BMIs, I've raised them all the same.

I'll definitely talk to her about the medications mentioned and maybe she can then bring that up with the professionals! Thank you.