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Weighing the risks

Despite many warnings, gastric bypass is growing more popular. Now, even teens are having the surgery. If your teenager wants to do it, should you allow it? NBC’s Al Roker decided to look at the pros and cons himself.

Dear Mom: I want to talk to you about something that has been on my mind for a very long time. I hope you can be understanding about what I am about to say. Well, for a long time, I have been thinking about having gastric bypass surgery… For the past few years, I have lived an unhappy life, I never had any energy and was always depressed...

It is a son's letter to his mom, describing what he feels is his last chance for a normal life. Jonathan Lebron, after writing the letter, approached both his parents, asking permission to take what seems to be a drastic step for someone who is only 17 years old -- gastric bypass surgery. But at 365 pounds, Jonathan is desperate.

Al Roker: "What made you decide to think about gastric bypass surgery? This is a serious, serious deal."

Jonathan Lebron: "I've been through so much. I’ve tried so much and all I've gotten out of it is failure. This is something I want to do now so that I can have the rest of my life to enjoy."

Jonathan's parents share his concerns about his weight, but never would have suggested gastric bypass as a solution. In fact, they were unaware that Jonathan had been spending two years quietly looking into the surgery.

Roker: "Unbeknownst to you, he's been researching a gastric bypass, and he writes you a letter… Tell me about that."

Hilda Lebron: "I was shocked. I mean I always knew he had a problem with his weight. I always knew that was a big thing for him, but I never in my life would have thought that Jonathan was researching something like that.

Luis Lebron: "The letter really showed me how unhappy he was and Jonathan never really portrayed that. I knew he wasn't taking part in normal activities, but he was always the happy guy."

Roker: "The happy fat guy."

Hilda: "Exactly."

Luis: "Exactly, and that was the stereotype, the happy fat guy."

Roker: "And I can tell you, very few fat people are happy."

As we all know, teenage years come with their own built in insecurities, but for those of us who grew up overweight, we realize everything is compounded by being heavy. Simple childhood pleasures like going swimming, trying to play sports are anything but enjoyable when you fear all eyes are on you.

Jonathan: "I think a lot of people who see me and don't know me, they think that I’m just, you know, a failure. I'm not good to be around. You know, I’m not a good person."

Roker: "So in other words, you feel like your weight has caused people to look at you in a negative way?"

Jonathan: "Yes."

Roker: "And does that affect how you look at yourself?"

Jonathan: "After awhile from thinking those things over and over again, you start to feel the same way about yourself."

Jonathan wasn't always heavy. That started when he was about six. In fact, as a baby, Jonathan was anything but overweight.

Hilda: "He was a premie… like three pounds two ounces."

Luis: "When we got him home, of course grandma says, ’Don’t worry, we'll fatten him up.’ You know being our culture, we're Puerto Rican, you tend to think if a person's thin, he's not healthy."

Roker: "Actually, that's a lot of cases. It’s cultural, it's Jewish, Hispanic, African-American. Let's put on some weight. That's healthy. We can afford to eat."

Luis: "Exactly and we tend to eat the wrong foods, you know, everything is fried and that type of stuff, so I think that had a lot of effect."

But mealtime at the Lebrons’ did not have the same effect on Jonathan's two brothers.

Roker: "Do you ever wonder, why did you have the weight problem and they don't? I mean, I've got brothers and sisters who had no weight problem and I think, what's the deal, what's up with that?"

Jonathan: "I’ve thought that. I feel like I never really understood why you know? I always thought, why am I the heavy one?"

Jonathan attributes his obesity to eating big portions, but, he has tried, over the years, to control his weight. There was Weight Watchers, Atkins and he joined a gym. Nothing gave him long lasting results.

Jonathan: "I would lose maybe 20, the most 25 pounds and you know I would stay on it. But I would plateau, you know, stop losing weight for a time and then I would just gain a lot of it back and more than I started."

For the surgery to work, Jonathan is going to have to try harder than ever before. He will, as I learned firsthand, have to make dramatic changes to his eating habits and lifestyle, something that may be difficult for a teenager. Still, Jonathan's parents support his choice.

Roker: "Do you worry that this is a decision that should be left in the hands of a 17-year-old?"

Luis: "We've tossed this back and forth, but this is what he wants. I think it's medically -- even though he's so young, they've done so many, that it's a procedure that I believe in the medical science."

Dr. Christine Whyte: "It's about giving young people a chance at life."

Dr. Christine Whyte, a pediatric surgeon at New York City's Children's Hospital at Montefiore, never imagined she would be performing weight loss surgery on teens. It's controversial. Some insurance companies even refuse to cover the costs. Though an exact number is hard to come by, it's estimated that up to 500 teenagers each year have surgery to attempt to deal with their weight problem. And with 15 percent of children in this country being classified as obese, such surgeries are increasingly being considered for younger patients. 

Roker: "There are those who say, gosh these are teenagers. Some of them still have baby fat on them. Why do it when they're in their teens?"

Dr. Whyte: "By doing the surgery at an early date we can help the kids who already have problems, but more importantly we might be able to help kids before they get severe problems."

Dr. Whyte hopes this will be the case for Jonathan. He is a teenager who suffers from adult ailments like high blood pressure, acid reflux, knee and back pain. Still, the risks that come with gastric bypass surgery can't be ignored.

Roker: "There are complications that can occur -- chronic diarrhea, vomiting, malnutrition. Even some people suffer from depression. Adults may be better equipped to handle it than teenagers. Or do you think that's the case?"

Dr. Whyte: "I think time will tell how well teenagers cope with the changes in their body after surgery versus adults. And we work with the teenagers in advance to help them cope with the fact that one of these mornings they are going to wake up after their operation and they wont be able to eat the way they used to be able to eat and their body's going to change."

To prepare for the surgery, Jonathan, like all adolescent weight loss patients in Montefiore's obesity program, has gone through psychological testing and spent over six months meeting with social workers, doctors and nutritionists. Other criteria for patients include being at least 15 year old, having a body mass index of 40 or more –- meaning, needing to lose at least 100 pounds -- and dieting has to have already been tried.

Michelle Parsons thought the gastric bypass surgery she had eight months ago at age 18, would be the solution to years of unhappiness over her weight, which, after many failed diets, peaked at 250 pounds.

Michelle Parsons: "I knew that this is what I wanted to do and I knew it -- it's what I made up my mind to do. In my mind this is what would have changed my life."

Doctors at the Massachusetts hospital where her surgery was performed warned Michelle there would be an adjustment period after her operation. Still, while the surgery successfully led to weight loss, Michelle was unprepared for what she felt emotionally.

Michelle: "I couldn't cope. You know, you don't realize that not being able to eat will affect your entire life. And there's nothing they could have said before the surgery that I ever would have expected that -- never."

Michelle’s feeling of loss was so severe, that a few months after her operation, she became depressed.

Michelle: "Food was such a huge part of my life. And I think it is for so many people who have issues with their weight. Food is just there for you and it's not anymore and it's like losing your best friend."

Michelle thought she was prepared, thought surgery would cure her unhappiness. Jonathan also thinks he's ready for the surgery and the changes that come with it. But Jonathan's positive attitude would be tested. Just one day before his scheduled surgery there's a snag. The Lebrons’ insurance company has unexpectedly refused to pay for Jonathan's operation, saying he's just too young.

But Jonathan would be surprised again, this time with good news. Montefiore Medical Center strongly believes bypass surgery will improve Jonathan's life and that he is prepared both physically and emotionally. So, as it occasionally does in such cases,  the hospital will proceed with the $25,000 surgery. Montefiore will continue its efforts to get the insurance company to cover the costs, but if that fails, the hospital will perform the operation without charge.

Jonathan's surgery, like my own, is performed laproscopically. Through a series of tiny incisions, surgeons insert a type of telescope that is connected to a TV camera. Jonathan's stomach is stapled to create a small pouch, about the size of his thumb. Then a section of the intestine is attached to the pouch to allow food to bypass part of the digestive path. This bypass will reduce the number of calories Jonathan’s body will absorb. Typically, as was Jonathan’s case, the surgery lasts about two hours.

Roker: "Are there different dangers or things that you have to watch out for with bariatric surgery in teenagers as opposed to adults?"

Dr. Whyte: "One of the things about treating teenagers is they don't always listen to you, so you have to very carefully follow teenagers who have this operation."

It’s now been two months since Jonathan’s surgery, which ultimately was covered by insurance. And so far, so good, although the adjustment has been tougher than Jonathan anticipated.

Jonathan: "There was a time where everything I would eat for a whole week, I would throw up. And then I felt bad, thinking about was this the right thing? You know, am I going to live the rest of my life feeling sick every time I eat?"

But as time went by, Jonathan grew more accustomed to the restrictive post operative diet. After spending one week drinking only liquids, he moved onto three weeks of purees and now eats small meals three times a day. Each meal consists of up to 1/2 cup of foods like scrambled eggs or boiled chicken -- a big change from Jonathan’s old typically super sized meals of fried chicken and rice.

Jonathan: "Seeing the small amount that you'd be eating and even though you weren't hungry, in your mind, you weren't used to seeing that little bit, a couple of ounces. It hits you and like wow, this is all you'll be able to eat for long time."

Jonathan must also take an array of protein supplements and vitamins to make up for the nutrients he no longer gets from food. And the two months of drastic changes seem to be working. He has so far lost 77 pounds from his original weight of 365.

Jonathan: "Sometimes I think I have a lot more to go and will I ever get there, but I was able to change so much and I know what I have to do to stay on track."

Michelle Parsons, who had been depressed after her gastric bypass, is getting more comfortable in her new body, which eight months after surgery is 100 pounds lighter. The feeling of loss over not having food to rely on is slowly lifting. One of Michelle's replacements for food is shopping. It's changed from a dreaded activity to a pleasurable one, something I experienced as well.

Michelle is also working part time at a place she would have avoided in the past -- a restaurant, ironically called Zaftig's, which means chubby in Yiddish.

Michelle: "Just being at a restaurant where people are looking at you, and the thought of working in a restaurant, never in my entire life, but I’m comfortable there now."

Michelle's getting used to her new relationship with food, but it's been a process that took her by surprise.

Michelle: "I think everyone who goes through this thinks it's going to be a magic pill. And it's not. This is not a magic pill. This a year of hard work and for the rest of your life."

Jonathan: "It's not easy, it's not like a one, two, three fix. But with effort and work from my part it will all be worth it."

Jonathan, and his family say so far they have no regrets, as Jonathan looks to the future with newfound hope.

Jonathan: "I'm becoming more healthy. And this is something I want to do for the rest of my life. I want to be able to have a long healthy life."