EAP 2nd Argument

ARGUMENT 2: It causes permanent changes of patients’ lifestyle

Many people thought that their life will change after undergoing a bariatric surgery. Although it is true, unfortunately, the changes are unpleasant and permanent. Adolescents have to face an array of lifestyle modifications that are not only severe but radical as well. Because of their immaturity, this often leads to psychological, emotional, and social problems.

One thing that is going to change is dietary habit. Because the stomach is smaller, patients have to eat in smaller portions. While this is a change that one could hope for, it is very difficult to deal with, and they are having a hard time to adjust to their new dietary routine. If they eat more than their new stomach can handle, they will vomit (Lee, 2009). On the other hand, Benson-Davies and Quingley (2008) reported a case study on a woman who “suffered from severe food aversions that inhibited a normal eating progression from liquids to solid food following surgery” (p. 357). Seven weeks following the surgery, she still took liquid-form foods without protein from meat sources or supplements. The reason she stated was “phobia of food textures and taste alterations” (p358).

Besides dietary changes, patients also have to be prepared for changes in their emotion and psychology. Many of them cannot cope with the loss of food and become depressed. Roker (2004) reported about a teenager who underwent bariatric surgery, hoping that it is the solution to her overweight problem. However, she was unprepared emotionally for post-surgical dietary regime. She felt as though she has lost her best friend and a few months following her surgery, she was depressed. Other patients were gone through addiction transfer, where they shift the addiction with food into something else, like shopping and alcohol (Fry, 2008).

Furthermore, patients are tied to a lifelong commitment to a hospital for post-operative care. They need to be assessed whether there is any medical problem or presence of complication from the surgery. According to Warman (2005), “adolescents’ follow up visits are scheduled after discharge at one week, four weeks, three months, then every three months, with laboratory evaluation every six months, until weight loss is stabilized (usually one to one and a half year after surgery), then twice per year” (p. 283).

Apart from that, they need to take a lifetime nutritional supplementation and be closely monitored for vitamin and mineral deficiencies (August et al, 2008). This can be quite challenging as adolescents often do not listen to advices and recommendations. Xanthakos and Inge (2006) stated that less than 15% of 34 adolescents who underwent gastric bypass took the recommended supplements.

Because of permanent changes following bariatric surgery, one should really think before opting to surgery and be prepared for these consequences. Saunders (2009) reasoned that “it is hard enough to ask adults to tackle these issues, but a lot of people are asking whether or not this a burden that we should be putting on teenagers.”

EAP 1st Argument

ARGUMENT 1: It causes deficiencies of nutrients essential for growth

Our body requires nutrients in order to function normally. In addition for a still-growing person, nutrients are needed for growth. However, after undergoing bariatric surgery, nutritional deficiencies are prone to happen. It is a problem that cannot be avoided because it is closely related with changes of the gastrointestinal tract. This, if no medical attention is given, can lead into serious and life-threatening complications.

Sullivan et al (2006) stated that, “nutritional deficiencies documented in patients post Roux-en-Y gastric bypass include thiamine, folate, calcium, vitamin B12 and D, and iron deficiency.” It also stated that neuropathies and skin integrity breakdown are demonstrated among patients who did not take appropriate dietary supplements (p. 408). In addition, Alvares-Leite (2004) also agreed that thiamine deficiency along with regular vomiting is frequent among patients who underwent bariatric surgery.

Weight loss in bariatric surgery is achieved primarily by two mechanisms; restricting food intake, and bypassing the absorptive and secretory areas of stomach and small intestines (Xanthakos and Inge, 2006). Along with that, nutritional deficiencies are also presented because of these mechanisms. Restricting food intake means smaller food amounts, hence fewer nutrients are taken. Bypassing certain parts of stomach and small intestines reduces the capability of the organs to absorb nutrients effectively. It is further confimed by Alvares-Leite (2004) who stated that “nutrient deficiency is proportional to the length of absorptive area and to the percentage of weight loss” (p 569).

Xanthakos and Inge (2006) further clarify on how macronutrient (protein and fat) and micronutrient (vitamins and trace minerals) deficiencies can occur because of the mechanisms. Reduced food intake leads to protein deficiencies, while bypassing the gastrointestinal tract decreases the secretion of gastric acid, resulting in reduced bioavailability of certain nutrient that requires gastric acid for it to be released. Moreover, because of shorter phase of gastric digestion, nutrient supplements that are not in liquid, suspension or chewable form are passed into the colon unabsorbed.

A review done by Matrana and Davis (2009) emphasizes the effect of vitamin deficiency following gastric bypass surgery. A case is presented regarding a 37-year-old female who underwent gastric bypass surgery, yet did not receive any post-operative care. She developed complications, which arises from deficiency of thiamine rather than the surgery itself. After three weeks of hospitalization and rehabilitation, the patient has showed a slow but progressive improvement.

It is clear that nutritional deficiencies are dangerous and can risk life. If the deficiencies can cause problems in adults, it will be more prominent in adolescents who need nutrients not only for maintaining normal bodily functions, but also for development and growth. It is agreed that bariatric surgery is offered to correct obesity problem, but it introduces another problem – nutritional deficiencies – which needed another lifelong corrective measure. Thus, based on this argument, bariatric surgery should not be offered to adolescents.

My EAP: Bariatric Surgery for Adolescents: Is It Right? Intro

Introduction

These days, it is not a strange sight to stumble upon parents with cute and chubby children. It is a sign of health, as the elders said. Chained to this belief, parents frequently feed their child without realizing about the nutritional consequences, often resulting in poor eating habits. As the child gets fatter, parents think that they have done a good job. What they failed to realize is that they are actually destroying their child’s life.

Obesity has reached epidemic proportion, and what worries us, the incidence has shifted towards teenagers and children. Statistics have shown that the number of overweight teenagers and children in United States has tripled for the past three decades, where approximately 15% of the age group is overweight (Buchwald, 2004). The trend has also been observed worldwide. In Malaysia, Sherina & Rozali (2004) quoted a research done by Ismail & Vickneswary (1999) that the prevalence of obesity children has raised from 1% to 6% in a period of only seven years. It is also quoted by the same author a survey done by Ismail & Tan (1998) that the prevalence of obesity is increasing with age.

Along with the distressing numbers, bariatric surgery has gained much popularity as a treatment for morbid obesity because of the high weight loss rate and improvement on patients’ health. Bariatric comes from Greek word which means obesity treatment. Thus, the term bariatric surgery refers to any surgical intervention in order to treat obesity. Buchwald (2004) stated that “bariatric surgery is the most effective therapy available for morbid obesity and can result in improvement or complete resolution of obesity comorbidities”. According to Weber et al (2008), there are currently two treatment options that are widely used; gastric bypass, and adjustable gastric banding. The choice of these treatments is based on least complications with significant weight loss. However, because of the high rate of weight loss and efficiency, gastric bypass is superior to adjustable gastric banding in choice of treatment.

Since then, there are suggestions that bariatric surgery should be offered as option to treat obesity in teenagers. In fact, it is estimated that up to 500 teenagers have attempted surgery to overcome their weight problem each year (Roker, 2004). Warman (2005) stated that at Magee Women’s Hospital of UPMC alone, 12 applications were received between 1999 and 2002, while more than 100 cases were recorded between 2002 and 2004.

Despite the increasing popularity, some experts oppose the idea of bariatric surgery for teenagers. Dr. Diana Farmer from UCSF Children’s Hospital stated in the Oprah television show dated 4 February 2008 that children are not ready to make decisions that will affect them for the rest of their life. Saunders (2009) also stated that a lot of people are asking whether this burden should be given to teenagers. Although the success rate of undergoing bariatric surgery is convincing in adults, the data for teenagers is insufficient and scarce (August et al, 2008). Thus, it raises controversy; is it really safe for them?

This paper will discuss the hazardous effects of both the surgeries and why it should not be done on teenagers. Thus, I strongly believe that bariatric surgery should not be offered as an option to treat obesity in teenagers because it causes deficiencies of nutrients essential for growth; permanent changes of patients’ lifestyle; and severe complications as a result from surgery.