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Image: Chelsey Lewis before and after bariatric surgery
Courtesy of Chelsey Lewis
Chelsey Lewis before and after bariatric surgery
Image: JoNel Aleccia
By JoNel Aleccia Health writer
msnbc.com
updated 9/20/2010 8:31:47 AM ET 2010-09-20T12:31:47

In 2005, Chelsey Lewis was a 456-pound white girl growing up in Tracy, Calif., who knew all too well the pressure to be thin — or at least not obese.

“I was kind of like the outcast,” recalled Lewis. “If I went out, I was always afraid of being judged.”

So at age 17, Lewis had a gastric bypass operation, eventually losing more than 200 pounds and becoming part of what experts say is a disproportionate bump in the race and gender ranks of adolescents who seek weight-loss surgery.

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White girls are far more likely than any other adolescents to undergo bariatric surgery, according to a new study of some 590 California kids ages 13 to 20 who had the operations between 2005 and 2007.

Although the white teens and young adults represented only 28 percent of those who were obese, they accounted for 65 percent of those who got surgery, according to the study published in Monday's journal Pediatrics.

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By contrast, Hispanic young people made up more than half of those who were obese, 52 percent, but accounted for only 21 percent of the weight-loss surgeries.

And though girls made up 43 percent of the overweight kids in the study, they accounted for 78 percent of those who got operations.

Girls worry more than boys
“Girls are a lot more worried about their appearance,” observed Lewis, now 22 and the mother of a 1-year-old with another baby due soon. “Boys can socialize no matter how they look.”

The study, which examined the types of weight-loss surgeries performed on adolescents, offered a few theories, but no conclusions about the race and gender differences, said Dr. Daniel DeUgarte, a co-author and pediatric surgeon at the University of California at Los Angeles.

“There may be cultural biases, there may be biases from referring physicians,” said DeUgarte. “It’s very complicated.”

Other weight-loss experts say that the trend that holds true outside of California. Dr. Thomas Inge, director of the surgical weight loss program for teens at the Cincinnati Children's hospital, says that between 60 percent and 70 percent of the obese young people he treats are white females.

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"Culturally, I do think there are racial differences in acceptance and even desirability of higher weights," he said, noting that he bases that on conversations with families about what their ideal weight loss would be.

But other bariatric surgeons say the reasons should be obvious: social pressures on girls and women and economic disadvantages for minorities.

“I think it’s a lot easier to be Big John in the United States than it is to be Big Joan,” said Dr. John Morton, an associate professor of surgery at the Stanford University School of Medicine. “And minorities don’t have as good access to health care as other patients.”

His view is borne out by new census figures that show far more blacks and Hispanics lack health insurance than whites. About 16 percent of whites are uninsured, compared with 21 percent of blacks and 32 percent of Hispanics, according to data released this week.

Some private insurance companies and some state or federal plans will cover certain kinds of bariatric surgery for adolescents. In the Pediatrics study, 71 percent of the young people used private insurance to pay for the operations, 12 percent used public sources and 17 percent paid for it themselves.

Morton was one of two doctors who performed the Dec. 8, 2005 surgery on Chelsey Lewis, whose operation was fully covered by her family's private health insurance.

Lewis said she believes that heavy white girls feel more pressure to lose weight. Girls of other ethnicities seem to be more comfortable with themselves, no matter their size, she said.

"It seems like white females tend to care more about getting acceptance," she said.

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About 5 in 100,000 teens get surgery
Overall, the number of adolescents of any race or gender who got bariatric surgery in California remained stable during the three-year study period at about 4.9 patients per 100,000. Still, that represents a continuing rise in the use of bariatric surgery in adolescents.

Nationally, the number of weight-loss surgeries performed on adolescents surged nearly five-fold, from 51 in 1997 to 282 in 2003, according to a study in the Journal of the American College of Surgeons. In the new Pediatrics study, 590 young people received surgery in California alone from 2005 to 2007.

Overall, that study showed a big change in the type of weight-loss surgery, with a 400 percent increase in the rate of laparoscopic adjustable gastric banding or LAGB procedures, which jumped from .3 per 100,000 adolescents to 1.5 per 100,000. At the same time, there was a nearly 30 percent decline in the rate of laparoscopic Roux-en-Y gastric bypass procedures, which fell from 3.8 per 100,000 young people to 2.7 per 100,000. Among those younger than 18, the use of LAGB outstripped bypass.

LAGB operations place an adjustable band or collar around the upper part of the stomach to reduce its size and induce weight loss. Gastric bypass surgeries make the stomach smaller and allow food to bypass part of the small intestine. 

Both procedures are used with caution in adolescents, and usually only when they’re more than 100 pounds overweight or in danger of diseases like diabetes and high blood pressure. In fact, the federal Food and Drug Administration has not approved the gastric band for use in those younger than 18, forcing doctors to use it off-label, with specialized consent.

Those concerns cover all races and both genders, experts say. But for patients like Lewis, who lost 100 pounds within the first six months of her surgery and then kept going, they’re far outweighed by the benefits.

“It’s been really good for me,” said Lewis, who believes she wouldn’t have had children or gone to college if she’d stayed so heavy. “I’ve been able to get out a lot more and to experience new things that I never would have done.”

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