Weight loss surgeries rise substantially among adolescents: research | Hacker News Reader

Weight loss surgeries rise substantially among adolescents: research

thehill.com

Here the American Academy of Pediatrics is calling for more surgery, but not a word about preventing the situation in the first place. Why are they so focused on highlighting sickcare? What about prevention education?

The researchers also noted that metabolic and bariatric surgery is a “safe and effective treatment” for severe obesity, saying that the American Academy of Pediatrics (AAP) issued a statement last year calling for increased pediatric access to these surgeries...

“The AAP has highlighted the need to educate pediatricians about the benefits of MBS for qualified patients,” the letter reads.

The surgery, if done right, makes it hard to impossible for the person to ingest too much food. Results can inverse if the person keeps trying to increase their portions with time, and they can’t get a second surgery, but if someone is committed, the surgery can be a stepping stone for them to fix their eating problem. That said, the reason some overeat is often depression and the lack of energy that comes from not being able to eat as much leads to worsening mental health. If you don’t know how to adjust your diet for a smaller stomach (more proteins and filling food, less carbs) the mental health issues grow worse.

The AAP advocates for 60 minutes of physical activity daily. This is old news.

From 2020, "A new AAP clinical report aims to give clinicians guidance to help patients achieve physical activity levels for improved health...

...Strong evidence shows that physical activity improves body composition, decreases cardiovascular disease risk and is a preferred treatment for fatty liver disease and prediabetes. Additionally, research shows benefits in children with ADHD and depression.

When it comes to health promotion, regular physical activity assessment and counseling can help improve gross motor development and physical literacy, academic performance, sleep and behavior, while it reduces teen risk-taking behaviors and helps prevent obesity and other chronic diseases. The benefits and value of physical activity extend to all children, including those with special health care needs."

Source: https://publications.aap.org/aapnews/news/12302

What would you believe they should recommend instead?

Probably physical activity and a healthy diet, both of which they've been advocating for for decades. This is an odd comment.

So they should double down on the thing they've been advocating for decades as the obesity epidemic has exploded, and not look at the only options that have proven effective. That seems like an odd recommendation.

Not really, plenty of people have "discovered" that proper food intake and exercise actually works. Very few follow through long term and they are looking for a pharma answer, which is profitable so sure they are willing to fill that want.

The term diet I'm avoiding here itself is viewed as a temporary change these days, but it must be a permanent change to actually work.

“[I]n urban areas, the U.S Department of Agriculture considers a food desert an area with no ready access to a store with fresh and nutritious food options within one mile.”

One mile? With such a definition of the term “food desert”, no wonder so many people are defined as being in one. Living more than one mile from a grocery store is hardly a “desert”. Most grocery stores deliver food now too, so even lack of ambulatory faculties is a poor reason to not cook wholesome meals for one’s family.

This study appears to have been created to create alarm about a possibly nonexistent or virtually nonexistent issue.

Edit: Sorry, I top-posted this accidentally. This comment is referring to a study that another user posted here regarding lack of access to food supplies in the US.

I think the problem with “food deserts” (kind of dramatic term but that’s probably the point) is that they are significant hurdles for the working class (maybe they can order, but can they justify that in their budget?) and serious issues for the very poor who don’t have transportation.

The important question is how many impoverished or nearly impoverished people live in a food desert.

Respectfully, I think you might have gotten used to the sas state America has ended up in. I'm in a reasonably sized city, and have fresh groceries less than half a mile away. My parents live in a suburban, approaching rural area - and have multiple grocery stores within a mile. Hell, I had fresh produce within a mile in a very small town in Alberta, at both apartments I lived in.

I can see the argument if most people were actually living someplace rural - but they aren't. Living in a city that's also a food desert sounds like it misses the point of what a city is for, to be honest.

Weight loss surgeries are an incredible tool with great research to back them up. Until the recent invention of semaglutides, they were the only tool that works for doctor prescribed weight loss (telling people to eat right and diet doesn't help outcomes at all, its more or less a waste of time).

> telling people to eat right and diet doesn't help outcomes at all

That's only because they don't listen to what you tell them. When people actually do eat right and diet, that works to lose weight 100% of the time.

I mean, based on the fact the new drugs are hormone related (they help lose weight by suppressing the hunger mechanics in the body) of course people "don't listen to what you tell them". You're telling them to, with will alone, totally ignore their own body's hormone disorder. I'm sure narcoleptics can also just stay awake when you tell them, or I'm sure people with thyroid disorders can also just overcome it with sheer will.

I think no one willingly eats themselves obese. Something else must be going wrong-- an eating disorder caused by trauma, or a hormone disorder, or something. Normal-sized people just don't feel the need to eat that much and genuinely find overeating to be deeply unpleasant, because their bodies are responding healthily to too many calories ["I shouldn't have had that extra slice of pizza, I feel like shit"].

I think the real problem is that the vast majority of people know nothing about nutrition and thus are unable to make healthy decisions.

Nutrition, diet, and cooking should be required courses in high school.

The thing is that nutrition education hasn't been proven to work for obese people. They do not educate themselves thin, no matter how much education they get. It's very clear to me something is going wrong at a greater population level. There's no education needed to think "nah I don't need dessert" or "yeah I'm done, I'll take these leftovers home". That's just listening to your body. Something has gone wrong where obese people's bodies aren't responding properly to food.

My theory, based on nothing, is that up until recently food was scarce so when it was available we had to eat for survival. The more calorie dense something was the more likely we were to survive.

After millions of years of evolution we've only recently had an abundance of food in many places and our instincts to eat it all haven't evolved quite yet.

(To confirm again, this is just my personal theory and I know nothing about the space)

Anyways; personally I've found education to be very helpful. It does take some will power but that's the same for anything. Lots of people find drinking fun; why don't you wake up and drink in the morning? Relaxing, hanging with friends, and doing hobbies is more fun than work so why don't we all quit our jobs to pursue those things?

We know drinking can be destructive and is bad for us so, addicts aside, we know to drink with moderation.

We know we have bills to pay to survive so we know we can't quit our job.

With proper education people might realize their food choices are killing them and make healthier choices. Most people just simply don't know.

It won't work for everyone, but some people are alcoholics and some are unemployed, but having the proper education and tools would absolutely empower a lot of people to make better choices and live healthier lives.

People's diets are literally killing them and they don't know any better.

Fat people are fat, not stupid. We've been making fun of fat people overeating since Durdley was chowing down on Harry Potter's birthday cake. Educating obese people doesn't make them thin. There's no studies supporting it.

I never said they were stupid, and I also never implied they stuff their faces with cake. People will order a salad thinking it’s a healthy choice and not knowing it has as many calories as a burger.

That's not the problem. Nutrition education programs have been tested in huge trials and have no effect on long term weight loss.

1. Start business

2. Grow revenue to 500k/year

3. Pay yourself 100k per year.

When people actually do this, it cures poverty 100% of the time.

Or put another way, imagine a drug that cures schizophrenia but that causes the patient to be in such excruciating pain that only 1% continue to take the drug after a year. On an intent to treat basis the drug is useless, but if you look at study completers it's 100% effective. Should we still look for other treatments for the condition?

No, it's because people can't just fight what their body tells them they need for any significant amount of time. It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens - at least without surgery.

> it's because people can't just fight what their body tells them they need for any significant amount of time.

Yes, the body is saying "nourish me" and they're feeding it food that is high-calorie and low-nutrient. So the body keeps asking "nourish me". And they feed it the same thing. We shouldn't be so quick to blame the body for the mind making poor decisions.

> It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens

But why is that? Have they developed new better habits, or simply put the proven bad ones on hold? Is the whole family / household in on the effort, or is it usually one very obese person trying to change, while the obese and overweight under the same roof aren't making any effort (to change diet, exercise, and TV watching* routines).

The point is, we are known creatures of habit. We are also creatures known to conform to the surrounding norms. If the norms of the house are counter-productive then yes you're going to lose. If the norms once you leave the house (or turn on the TV) are against you, that doesn't help either (but it's a bit less impactful).

I understand it's a complicated social issue. But the biology and psychology / behavior aspects are fairly well known and documented. People don't want to believe that all that good tasting food is bad for them. They don't want to give up the idea that ice cream is for daily consumption (not limited to special occasions). Etc.

I agree. It's not easy. But the denial doesn't make it any easier.

* My parents loved to watching cooking shows, and their diet reflected it. I wish I had $20 for every time I said, "Food is for nutrition, not a pleasure center...Rachael Ray is not your friend."

I'd like to add that Oprah spent years pushing the idea of "love yourself" (regardless of how unhealthy that might be) now has a diet-friendly food line (a la Weight Watchers). And yet no one stops to say, wait didn't she help normalize this problem?

Lots of people become obese on excellent food. It's far more common than obese people who become normal weight for a long period of time.

The food doesn't really seem to be the main issue (though it probably adds its own set of health complications). Newer research tends to suggest that the body is not saying "nourish me", it's saying "I need to be 120kg" (the lipostat model), and it doesn't seem food is what's affecting that. Various other substances are known to cause similar effects (hormones, lithium, possibly PFAS and other plastics), but it remains to be seen if any of them is present in high enough quantities to be the root cause.

That happens. But it's not the majority.

I agree. There are also too many unknown environmental factors.

Nonetheless, too many calories ingested, and not enough calories burned is only going to go in one direction.

btw, I recently read "The Comfort Crisis" by Michael Easter. I wouldn't say there was a whole not a new info (for me) in it. But he does a very good job of bring a wide range of info together and presents it in a way that's easy to consume (but not in a junk food sort of way). I think it's worth a read for anyone who looking to improve their health via diet + movement.

Yes, but that's pointless as a policy for doctors and healthcare in general.

And telling cats not to murder random birds doesn't help outcomes at all, but only because the cats don't listen to what you tell them.

Here's a follow up to this:

PSA: Every legitimate long term study of major non surgical weight loss shows that it doesn't happen for the vast, vast majority of people. It's basically freakish when succesful in the long term. 1) ["In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within 1 year, and almost all is regained within 5 years. "](http://www.ncbi.nlm.nih.gov/pubmed/1580453)

2) Giant meta study of long term weight loss: ["Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3% of initial body weight."](http://ajcn.nutrition.org/content/74/5/579.full)

3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years."](https://fatfu.wordpress.com/2008/01/24/weight-watchers/)

4) [The reason why it's impossible seems to be that although calories in < calories out works, the body of a fat person makes it extremely difficult psychologically to eat less.](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...) This is borne out by the above data.

5) [The only thing that does seem to work in the long term is gastric surgery.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/)

Moreover, you won't find any reputable study on the web where the average person in the study lost 10%+ of their body weight and kept it off for five years. Not even one.

I guess I'm a freak, I dropped 30~40 lbs and all it took was a permanent overhaul of my diet (keto/paleo) and committing to some exercise (close rings on apple watch most days). You know, discipline. About 4 years now...

People hate when I tell them the secret is proper diet and exercise, they just don't have the discipline.

Kudos to you! Let that freak-flag fly!!

Keyword: permanent.

Most people go on a "diet" to make up for (bad) habits. They make some progress. But then return to those original (bad) habits in denial that those were the cause.

Ice cream (for example) was poison then. Diet or not, it's still poison. A small bowl now and then? Sure. But a nightly night-cap? Nah. Healthy doesn't work that way. No one want to hear that, let alone change habits that limit such exposure*.

* My rule for the supermarket...if I don't buy it, I can't eat it. I'm convinced you would guess people's weight - and general health - by looking at their shopping cart.

Is this satire?

Sadly, this is the attitude of some obese people...

First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person.

It's obviously possible to lose weight with diet and exercise.

It is completely useless (scientifically) for a doctor to say, "Go exercise and lose weight." Same for other similar things, like weight loss and nutrition education. It's been proven over and over again in scientific literature that it doesn't affect outcomes at scale, every trial shows the same thing.

People know that they should eat less and exercise, saying it is not the issue.

Pot - Kettle on that.

For a non-scientific case study of 2 - I know one obese person who has had gastric surgery, and complication from it - it hasn't helped them, and one formally obese person who successfully lost 20kg and has kept it off. Consider perhaps that trial participants may in some sense be self-selected from the sector of the population for whom normal diets don't work.

fwiw... the latter person strongly recommended deleting all sugar from the diet.

"First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person."

I never said you were obese, I said this is the attitude of some obese people. Not the same thing, so maybe reading comprehension is something you need a little bit of help with.

Judgmental? Probably a little...As someone who lost over 100lbs and has kept it off for over a decade the old fashioned way...exercise and portion control...hearing people make excuses for why they cannot do the same gets kind of lame after a while.

It is the attitude of most people who have tried to lose significant weight (tens of kg).

Note that I personally don't think surgery or semaglutides are a great solution, since they still don't attack or even try to identify the roots of the issue.

The one issue I could not see a workaround for while living in the US was the food (short of getting *everything" flown in from the EU). That is why there is an obesity epidemic, the food is poison - and it is the entire chain, from confectionery in the grocery store to a meal at a high-end restaurant.

Back in the EU, everyday I am grateful for the simple, good, food that I can get even without making much effort - whether that be street food from a kiosk, or something I put together at home from basic supermarket ingredients.

I am lucky in that my body tells me what is good/bad food and what/how much it needs. It remains a mystery to me how others lose control of their weight.

Are you saying that there are not supermarkets with basic wholesome ingredients from which to make healthy meals in the United States? That you were unable to buy grass-fed organic beef, pasture raised chicken, and organic vegetables and fruits? Where did you find this wasteland in the US? I have yet to see one that cannot provide these basic ingredients.

Certainly you can have it in a metropolis downtown, or within reach of a well-off suburban neighborhood. (Not very cheaply though.)

But https://en.wikipedia.org/wiki/Food_desert is a thing, especially in poorer, less densely populated areas. The problem is not just the absence of nicer options to normally nutritional food like rice or beans; it's also the prevalence of high-carb foods with very intense taste that pander to cravings and actively form them, while providing a wrong caloric balance (plentiful but very fast carbohydrates).

Something like 6% of Americans actually live in a food desert. A worthy problem to solve, but a total strawman when it comes to addressing obesity and food choice behavior.

For a substantial amount of Americans that is exactly what is happening.

https://moveforhunger.org/harsh-reality-food-deserts-america

“[I]n urban areas, the U.S Department of Agriculture considers a food desert an area with no ready access to a store with fresh and nutritious food options within one mile.”

This study appears to have been created to create alarm about a possibly nonexistent or virtually nonexistent issue.

For sure - but when I cooked these 'basic wholesome ingredients' the results were not as expected, for example 'lean' steak mince that filled the pan with so much fat? water? I had to drain it off as I fried. To be fair the veg wasn't too bad I think, but anything that requires rearing or processing is going to be filled with corn byproducts and goodness knows what else.

Surgery is just a bandaid on a systemic problem. We still don't even know why we are obese! Certain groups say carbs are the devil (what about Japan, China who eat a lot of rice and keep their obesity rates very low?). Other groups say it's saturated fats (what about the thousands of years history we have of eating fats? Obesity is a very recent problem).

You will probably get fatter living in a suburb driving everywhere rather than say NYC. But that's not enough to explain the difference between countries.

What about pollutants? The food, the water, the air, the feed for animals, the antibiotics, pesticides, seed oils, microplastics?

Can you stay lean without looking emaciated at any age?

It seems many people get a belly as they age, but the face still looks normal.

Can you prevent this with a diet or will your face look haggard?

Human body is built to be economical. If you don't use muscles regularly, they degenerate to the size sufficient for your normal load.

If you want to look athletic, the only way is to be athletic, that is, spend significant effort working your muscles, proving to your body that you actually have a use for them. For most people it means a gym, or a barbell at home, or some kind of athletic sports, several days a week.

If, on top of that, you don't want a belly (which is a normal way for the body to store some energy reserve near the center of gravity), you also need to limit your intake of carbs.

You will look spindly if you remain sedentary and eat fewer calories, yes. Importantly, you can eat the same amount of food if you eat things that aren't laced with sugar and have higher fiber content. This is a good rule of thumb for cutting the excess calories when you're first starting out.

The trick is to metabolize the food you eat. You do that with exercise, primarily cardio. Then your body's new homeostatic program also involves "supporting the frame of the body during physical movement" and you begin to develop some muscle, preventing the emaciated look.

    develop some muscle, preventing the emaciated look

Muscle in the face?

With a reasonable amount of muscle mass, you don't need to reach as low of a body fat percentage to look fit. With regard to your original comment, yes there are millions of people who remain fit, lean, and without a "belly", as you put it, in older age.

Systemic problems require systemic solutions. Until we confront that sugar is something that people can get addicted to we won't be dealing with the root of the problem.

I think each generation tries to be more "real" than the previous generation.

At first social media allowed us to express "who we really are" by providing us tools to present "who we think we are". This was more "real" in contrast to the suit & tie professional persona many were shoehorned into. (Which was more "real" in contrast to traditional work-husband/housewife roles, since it was theoretically gender-blind)

Now social media personas feel too "fake". Being physically fit in the real world is one of the only hard-to-fake ways to stand out as "special" now.

Is it covered by medicare/medicaid?

The average bariatric surgery costs $7,400 to $33,000 before insurance coverage. [1] It's safe to say that the number of adolescents undergoing the procedure would be higher if it was cheaper.

For comparison, a good pair of running shoes costs $100, a new, quality bike costs $500, and a gym membership is $50 per month.

[1] https://www.goodrx.com/conditions/weight-loss/bariatric-surg...

I've lost 120lbs. I'm a PM so I A/B tested different methods to lose weight until I found one.

Exercise did almost nothing. It helped start my metabolism here and there. The real weight loss came from just eating as close to 0 calories a day as possible. Water, lettuce, whatever gets you full. It's a grueling process. It's not something you do because you love your body and your habits. You have to hate them.

Feel free to recommend running shoes and gym memberships to people. In my experience, your comment isn't grounded in data, experience, or even helpful. It comes across as dismissive and wanting to sound right.

The people doing these operations are suffering through a level of anguish you can't imagine. They are well aware of your trite advice, and unable to get their problem solved. That's why they turn to painful, expensive surgery.

It's a problem, and playing armchair life coach with gotcha one liners isn't going to solve it.

Most people would probably lose a significant amount of weight just cutting out beverages with calories in them.

A step further is to cut out fast food, boxed food, or anything pre-made. You should be doing 90% of your shopping in the produce/meat/dairy sections of the grocery store. The vast majority of anything you buy in aisles is either bad for you or incredibly calorie dense.

Unfortunately nutrition doesn't seem to be taught in high school, and cooking at home is an optional course. Learning how to take care of your body and having the tools to be healthy if you choose is beneficial to everyone; much more useful in day to day life than almost anything you learn after grade 8.

> Most people would probably lose a significant amount of weight just cutting out beverages with calories in them.

This hasn't been borne out. Coke zero, sprite zero, pepsi zero, etc. are widely available, tastes the same as far as I know, and we haven't solved the obesity crisis since they came out.

Fruit juice, Coffee with cream and sugar, Gatorade/sports drinks, Alcohol

Those all have zero or low-cal options, and we haven't solved obesity.

That's kind of like telling a smoker all they need to do is quit smoking. It's true and it sounds easy enough but it's actually super difficult. I quit smoking. It took 11 attempts and I needed a dedicated mental framework which I found in the book The Easy Way to Quit Smoking which I highly recommend. Point being these people are going to need dedicated help to dig into why they have these habits and education to teach them how to cook and eat healthy neither of which are cheap either.

The good old "have you tried not being sad" approach to health.

I lost a bunch of weight once, but like many others I didn't keep it off. Having a harder go the second time around. If it were easy nobody would be overweight.

Are you implying that running shoes, a bike, and/or a gym membership are a replacement for bariatric surgery? Will you suggest salads as well next?

The magnitude of the obesity epidemic should really give people more pause when imagining simple fixes like this. It's becoming more and more clear that this is not simply a problem of lifestyle, but very likely environmental factors at least as problematic as leaded gasoline was on IQs.

Yes this seems obvious to me too. The whole population just suddenly in the 1970's started eating more and exercising less? And we as a society have no idea what is causing it, and there seems to be no sense of urgency to find out.

Here's the environmental factor: massive amounts of sugar and syrup. Ban companies from pumping kids with high fructose syrup and sugar. Ban the sale of milk, yogurt, bread, cereal, juice boxes, sodas, and any other foods contaminated with high fructose syrups and sugars. Only then can we actually say we are fighting this weight problem. Everything else is lip service.

20 minutes of running is negated by a single cookie. Exercise alone is an exceptionally difficult way to lose weight and telling people to just exercise more is not a systemic solution.

I wouldn't be surprised if people are overeating by 1k calories/day. It takes a substantial daily gym commitment to burn that much, you're better off eating better in the first place (which unfortunately can be easier said than done)

Exercise is way less important than diet for weight loss, and eating less is free.

Presumably plastic surgery next for kids. Trickle down, like eg mobile phones, at first for a few adults, then many adults, a few children, then many children. As things become cheaper they spread to the younger; things including practices. Enter moral philosophy, a topic too big for chit chat.

Great discussion.

Even though there has been a body positivity movement and large brands (Target, Victoria's Secret) have changed marketing material to present there designs with people of all body types, the fact remains that humans are a visual species that are driven by aesthetic attributes of what is considered "beautiful" and "popular". Today that happens to be fit and athletic (or whatever the Kardashians are doing these days) and social media clearly presents these folks to the youth while simultaneously pushing the idea of medical procedures to attain these looks.

You make it sound like not being overweight is just about looks, but there are really important health reasons too.

Body positivity will go down as one of the most destructive marketing campaigns of all time. It helped lock in big food and big pharma revenues and avoid scrutiny at the expense of people's health and amplified healthcare costs for everyone.

It's not body positivity that is driving the obesity epidemic. It started long before that movement existed. Body positivity is just a coping mechanism because we don't have anything better.

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