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Should teens risk gastric bypass surgery?

More obese teens are trying gastric bypass surgery. But is it a good idea? NBC's Al Roker reports.

A son's letter to his mom describes what he feels is his last chance for a normal life.

"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..."

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? I mean this is a serious, serious deal.

Jonathan Lebron: I feel like 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 concern's 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 Hilda.

Luis Lebron: Yes.

Roker: 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: 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 times 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: Yeah. And it caused me not to do a lot of things.

Roker: Give me a  for instance. 

Jonathan: Well, I haven't gone to an amusement park in a long time. I don't want to be embarrassed going over there, and not being able to fit in one of the rides.

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 preemie. Jonathan was a preemie.

Luis: He was a preemie.

Hilda: 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.

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

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 life style -- 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 A) 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.

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 years 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.

Roker: Do you worry at all in the back of your mind that it's not going to be everything you hope it's going be?

Jonathan: You know, I try to keep my expectations realistic. But I just go into it with a positive attitude and hoping that things will work out.

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.

Two months after his surgery, Jonathan was doing well. Although the adjustment was tougher than he 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. The first week, he drank only liquids, then moved onto three weeks of purees and then small meals several times a day.

Jonathan must also take an array of protein supplements and vitamins to make up for the nutrients he no longer gets from food.

The hard work paid off. After only two months, Jonathan lost 77 pounds.

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.

And stay on track is exactly what Jonathan has done. Almost one year after his surgery, Jonathan has lost more than he now weighs. He is 185 pounds lighter, weighing 180 pounds -- far exceeding doctor's expectations. And it's not just Jonathan's appearance that has changed. His weight related medical problems, like high blood pressure, are gone. And there's the change that Jonathan considers the most dramatic.

Jonathan: I think the personality change was the biggest. I think I'm more outgoing now and I don't think twice about you know going somewhere. I don't have to think about what people will be thinking about me.

It's something Jonathan's parents have noticed as well.

Hilda: It's a different Jonathan -- 100 percent happier, outgoing.

Luis: And then the self-confidence factor, his self esteem is much greater now.

It's been a busy year for Jonathan. He graduated from high school and went to his senior prom -- without the concern he used to have that all eyes were on him.

Jonathan: I want to do more. I want to get more involved. I go out more with my friends.

And there's a place Jonathan has been waiting years to go to. Remember, before his surgery, when he wished he could go to an amusement park?

We went along with Jonathan to Coney Island's Astroland -- his first trip to an amusement park since he was a young child.

Hilda: Jonathan has always liked amusement parks from a young age. So the fact that he'll be able to fit now in one of the seats and the safety belt will be able to secure him better, will be a nice feeling.

Jonathan expects his life will now be filled with many new experiences. He acknowledges that gastric bypass is not a quick fix. He knows it means a lifelong commitment to a careful eating regimen, but now, he feels, it's a lifetime filled with hope.

Jonathan: I didn't see much as my future before. I felt like I would always be overweight and not be able to have a lot of chances in life that other people do. I do feel like it's a whole new beginning and I'm going to take advantage of that and make the best out of it.