Chandler Street

In just the past 30 years, obesity rates among children have tripled in the United States. According to the Centers for Disease and Control and Prevention, 13.7 million children and adolescents aged 2 to 19 years old are considered obese.

While education and increased access to healthier food choices has caused a decrease in childhood obesity rates in recent years, the World Health Organization has called childhood obesity “one of the most serious public health challenges of the 21st century.”

“It’s predicted that 60 percent of all adults and adolescents will be obese by the year 2060,” said SLUCare pediatric surgeon Gustavo Villalona, MD. “It’s a medical crisis that we need to address early in life and not later, when complications such as diabetes, elevated cholesterol levels and heart disease can negatively impact health.”

In 2017, Villalona and his colleague, pediatric surgeon Jose Greenspon, MD, reviewed data of all new clinic visits at SSM Health Cardinal Glennon Children’s Hospital. What they found was eye-opening.

“There were more than 600 encounters in our outpatient clinics with young patients who had a body mass index (BMI) over 35,” Greenspon said. “In 250 patients, their BMI number was over 40. It was astonishing.”

BMI is a screening tool to gauge obesity. It is a formula that uses a person’s height and weight to measure percentage of body fat. Normal BMI is under 25. You are considered overweight between 25-30 and any BMI number over 30 is considered obese.

For many children — and adults — changes in diet and nutrition can lead to weight loss and healthier lives. In some cases, however, more must be done to reduce weight. Within the past decade, bariatric surgery has become an option for older teens and young adults. While the surgery is a major decision, studies now validate the benefits of bariatric surgery at a younger age, with research showing that earlier intervention reduces the risk of complications related to obesity.

“A five-year study of adolescents who had undergone bariatric surgery found that they had better post-surgery outcomes than adults who had similar surgery,” said Villalona. “The adolescents lost 30 percent of their total body weight after surgery and kept it off for five years. More significantly, 90 percent of the adolescents who were diabetic prior to the surgery no longer had the disease and 70 percent were able to stop medications for high blood pressure. That’s a huge argument to say that earlier surgery is better for overall health.”

Clinical Dietician Darcy Kammeier with Chandler SSM Health Cardinal Glennon’s Healthy First program is the only adolescent-specific program in Missouri and has pediatric surgeons who specialize in bariatric surgery.

The Healthy First program

At SSM Health Cardinal Glennon, Dr. Greenspon is the medical director of the Healthy First weight management program.

Dr. Villalona serves as the medical director of its bariatric surgery component. It is the only adolescent-specific program in Missouri that has pediatric surgeons who specialize in bariatric surgery for young children. It also is one of only 13 pediatric bariatric surgery programs in the United States.

“We’ve had a weight management clinic here for many years,” said Darcy Kammeier, MS, RD, LDN, a registered dietitian in the program. “The program was expanded to include a comprehensive approach to treating obesity that includes surgery as well as weight management, exercise and nutrition counseling.”

Teens and young adults who are interested in reducing weight will first receive a comprehensive medical exam by physicians. They then discuss lifestyle modifications and diet changes with registered dietitians. Families may also see a physical therapist and nurse practitioner. Every Tuesday evening, the dietitians host cooking demonstrations and activities to help children and parents learn new recipes and stay active. “We ask that our families go to these events at least once a month,” said Kammeier. “It’s a way to provide motivation and check in with the families to encourage them to live healthier lives.”

Greenspon notes that weight management consultations are offered to families with children as young as 4 years old. Bariatric surgery becomes an option for children as young as 10 years of age if they meet criteria for surgery and carry a medical complication of obesity. SSM Health Cardinal Glennon holds free information seminars about bariatric surgery on the first Wednesday of every month at 6 pm. The Healthy First program also has a monthly support group for current and new patients.

A New Beginning

Chandler Street is having a great start to her freshman year at Southern Illinois University in Edwardsville. “I’m super excited, because I can do things that I wasn’t able to do before,” said the 18-year-old from Newton, Ill. Street underwent gastric bypass surgery in June 2019. In just two months, she lost 25 pounds. “I can feel and see the difference,” she said.

Street started gaining weight when she was in grade school. Born with extra bones in her feet and problems with her legs, she found it difficult to run or do almost any kind of exercise to keep active. “She had so much pain exercising,” said her mother, Mindy. “We eventually found an orthopedic surgeon who corrected the problems, but Chandler already had gained weight because her legs didn’t work properly.”

Once the orthopedic issues were resolved, Chandler was determined to lose weight. She had a loving family and supportive friends at school, but she admitted it was difficult at first to face the problem head on.

“It was kind of hard to walk into Cardinal Glennon because I had let my weight go so bad,” she said. “But I needed direction. Exercise and diet changes didn’t really fix it and I decided to have bariatric surgery.”

She found a welcoming, non-judgmental environment in the Healthy First program. It gave her confidence that she was doing the right thing. While learning about diet changes, a medical exam revealed that Chandler’s weight had caused some other medical problems, including the development of fatty liver disease, a leading cause for liver transplants in adults.

“Bariatric surgery improves fatty liver disease and stops it from progressing into cirrhosis,” said Dr. Villalona. “The surgery can also turn around diabetes and hypertension, and that’s a major draw to having the surgery.”

Chandler underwent a procedure called gastric sleeve surgery, which removes a portion of the stomach, thereby limiting the amount of food that can be eaten. For a month after the surgery, she was limited to an all-liquid diet, with special protein shakes and other liquids. She also had to take vitamins and other medications to ensure she was getting enough nutrients in her body. Over the following two months, she was able to eat pureed foods and then soft foods. Right before she started college, she began eating some normal foods. “The key difference is that I now eat six smaller meals a day instead of three meals a day,” she said. “And I focus on protein and then vegetables. The program has been great to help me figure out the right foods to eat and what foods to avoid.”

Chandler is one of a dozen patients who have undergone pediatric bariatric surgery at SSM Health Cardinal Glennon. They range in age from 12-18 years old. Dr. Villalona notes that the majority of weight loss occurs within six months to a year after surgery.

“We’ve had patients who were over 400 pounds who have had successful surgery,” he said. “One patient who was on four high blood pressure medications now is on just one. We also have had patients lose 60 to 75 pounds in the first several months.”

Adds Dr. Greenspon, “About 30 percent of the patients we see don’t qualify for surgery. But even if they don’t qualify, we are fully committed to helping any child who comes through our doors with other medically supervised weight management options.”