Weight management is a complex issue that can affect adolescents and teens both physically and emotionally.
How can we all be better informed about the different approaches to weight management, including diet, exercise, medication and surgery? James Healy, MD, MHS, Pediatric Surgeon with expertise in weight loss surgery, answers some of the most pressing questions parents have about weight management like, “What should my child consider before bariatric surgery?” and, “Is Ozempic safe for my child?”
Q: How can parents talk to teenagers and adolescents about managing their weight without making them feel self-conscience or getting into “skinny” talk?
A: As a parent, you know your child best, and know their personal triggers and sore spots. What I recommend for parents are three things:
1. Plan ahead before the conversation about weight comes up.
Look for an opening. For example, if your child says, “Oh, I wish I could lose weight,” that’s your opening. Now, see below.
2. When you do talk about weight with your teen or adolescent, lead with questions:
Look for an opening. For example, if your child says, “Oh, I wish I could lose weight,” that’s your opening. Now, see below.
What are your goals?
What do you love doing?
How does weight keep you from those goals?
Do you know someone whose weight has caused them illness? What was it like for them? Did you hear about them having diabetes, heart disease, liver disease or anything else?
3. Let them know there is hope! Many people give up after trying a few things, or treat a temporary setback as a total failure.
The generations of kids we’re raising today have a world of information at their disposal, some high quality, some low quality. If weight is something that bothers them, they’ve likely done their own research on some level.
Q: “Why am I overweight?” How does a parent answer this question?
A: People come in all different shapes and sizes, but obesity is complex. It’s not the same from any one person to the next, so avoid offering simple solutions. It’s important for both parents and children to understand that there are many factors that contribute to obesity, such as:
Genetics--some people are more likely to be obese than others due to their genes.
Diet—the lack of a well-balanced diet can lead to weight gain.
Lack of physical activity—not getting enough exercise can also be a contributing factor.
Hormones—certain hormone imbalances can make it difficult to lose weight.
Certain medications—side effects can cause weight gain.
Emotional factors—stress and depression can cause emotional eating which leads to weight gain.
Q: From a medical perspective, what is the most effective weight loss strategy for adolescents and teens? How can parents encourage these strategies?
A: The proven, most effective weight loss treatment is through a multidisciplinary medical weight management center, like the one Connecticut Children’s offers. Here, patients are evaluated thoroughly by multiple different specialists that:
Treat root causes of weight gain or obesity like endocrine disorders or certain tumors.
Identify opportunities to adjust or change medications that cause weight gain in collaboration with your prescribing doctors.
Evaluate your child’s psychological relationships with food and weight.
Discuss the pros and cons of different weight management strategies tailored to individual needs
If your child is actively looking to change their weight, knowing that there is an expert team approach can open the door to conversation. As a parent, it’s ok to say, “I don’t have all the answers, but I did hear of a great program that has a lot of different experts. Would you like to try it?”
This may take the pressure off of both of you.
Q: What are some do’s and don’ts of healthy weight loss for adolescents or teens?
A: Our whole culture is built around getting things done fast. We see many before and after rapid weight loss success stories. We don’t recommend very rapid weight loss because it can sometimes have negative health effects, especially if achieved through super restrictive diets and intensive exercise that is not sustainable—which we also don’t recommend. A more reasonable and healthy goal involves:
A slow and steady approach to lifestyle change—aim to lose on average one to three pounds a month.
Making gradual changes—then, when they get to their goal, maintain it.
Understanding it’s not all on them—saying to someone with obesity, “You need to diet and exercise more,” will not work or be enough because obesity is incredibly complex. For those who are already obese, meaning a BMI greater than 35, achieving sustained weight loss may not even be physically possible with diet and exercise alone, because the body has built up insulin resistance.
Q: Semaglutides like Ozempic and Wegovy are all over the news. As a pediatric surgeon and weight loss expert, what are your thoughts on teens and adolescents using these weight loss medications?
A: The decision to use weight loss medications can be complex. Families and their medical teams need to take into account every medication and supplement your child is already taking for any conditions they already have. Blood tests before starting these medications are absolutely necessary to help avoid any negative side effects. Medications are never prescribed at the first visit, to help ensure safe use.
These medications can be effective in the short term, but they are just one tool in the toolbox. Without the lifestyle changes to go along with the weight loss, the effect won’t last.
Typically, medications must be taken long term or even for life to maintain weight loss (for example: like blood pressure medication). Stopping them often leads to weight regain. The most durable long-term treatment is still surgical. We often see patients who need lifestyle change, surgery, and medications to successfully manage their condition.
Yes, you can certainly get access to these medications without the team approach, but many who do it that way do not see successful, lasting results.
Although surgery sounds extreme, it is a well-tested, consistent, effective, and safe method to lose a substantial amount of weight and keep it off for many years.
James Healy, MD, MHS,
Pediatric Surgeon, Connecticut Children's
Q: What should my child and I consider before weight loss surgery? (Connecticut Children’s offers robotic and laparoscopic sleeve gastrectomy and gastric bypass surgery for children with obesity who qualify.)
A: It’s difficult for parents to think about their child having weight loss surgery and also difficult for most people to gauge how risky it is. To put things in perspective, if a child has a gallbladder problem, most parents would not think twice about removing the gallbladder; same with an appendectomy for appendicitis. The sleeve gastrectomy, the type of weight loss surgery we offer most commonly, has approximately the same level of risk as a gallbladder removal.
The surgery is safest at younger ages and before multiple medical problems develop. It is also more effective at lower weights. If your child has a BMI >40, I strongly recommend at least having a conversation with one of our surgeons about the pros and cons.
It is important to consider that the weight loss effect from surgery can last for decades, and can seriously reduce and even eliminate risks of later liver disease, heart disease, diabetes, hypertension, joint pains/injuries, and many cancers. Many of the children we see already have signs of liver damage or even scarring of the liver, which can be reversed by significant weight loss at early stages.
Although surgery sounds extreme, it is a well-tested, consistent, effective, and safe method to lose a substantial amount of weight and keep it off for many years. The procedure takes about 1.5-2 hours, and requires an overnight stay in the hospital after. Most patients go home the following afternoon requiring no narcotic pain medications for home.
If your child has weight loss surgery at Connecticut Children’s, we’ll monitor them over time, address any issues they are having and continue doing so for about five years.
