At 19 years old, Mona Ramos felt tired Pediatric surgeon Thomas Inge, MD, PhD, was one of the first
all the time before she had bariatric to perform bariatric surgeries on an adolescent population.
surgery. Now, she’s climbing mountains. His long-term clinical research since has shown that the
surgery can not only ease certain obesity-related health
conditions in adolescents — it can even reverse them.
DIABETES & ENDOCRINOLOGY
In Reverse
CPAP machine. Her blood sugar climbed to
pre-diabetic levels.
The vicious cycle
Bariatric surgery isn’t the most intuitive treatment for type 2 diabetes,
particularly in teens. It’s a major surgery, after all, and there are far
less invasive treatments. But an increasing amount of large-scale,
long-term evidence suggests that, for many, it’s the most effective
treatment out there — and the younger they get it, the better. It’s a familiar story in the U.S., particularly
among minority populations. For Hispanic
youth like Mona, the rate of diabetes is about
17 percent of the total population. For Native
Americans, the rate approaches half. And as
studies follow these kids over time, the outlook
grows increasingly grim.
Mona Ramos was always active. She ran track and field and played softball in high school, all four years.
She loved hiking and the outdoors. She worked on her feet and did well in school, and so what if she also
loved Starbucks and Hot Cheetos? She liked how she looked. Lots of people did. “Complication rates are high,” says pediatric
endocrinologist Philip Zeitler, MD, PhD, national
primary investigator for the now-famous TODAY
study, the first large-scale research on treatment
options for diabetic youth, published in the New
England Journal of Medicine in 2012. Now 15 years
out from diagnosis, many of the study’s more than
600 young adults are developing eye disease,
kidney disease, high blood pressure. “They’re only
25 or 30,” he remarks. “They’re not 60.”
“My mother, her grandmother, always tells Mona how beautiful she is,” says Liz, Mona’s mom. “She’s like,
‘You’ve got to embrace those curves, mija.’”
But when Mona started gaining weight at age 15, Liz worried. She’d been overweight herself. She’d had
the sleep apnea and type 2 diabetes that came with it. Mona’s grandmother had diabetes, too. So did her
grandfather and three of her aunts.
It got worse after graduation. Without the structure of sports, Mona would go to the gym every now and
then, but it wasn’t much fun. She’d give up soda or Starbucks. She even tried Weight Watchers. She’d lose
a few pounds, but then her weight would level off and she’d get discouraged. A sleep study turned into a
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Mona was headed down that path. At age 19,
she couldn’t spend five minutes walking without
getting tired. She’d sweat just shopping for
groceries. For a girl who prided herself on being
active, it was embarrassing. She got depressed.
And the depression led to more weight.
Liz had been there. She’d gotten bariatric surgery, as
had Mona’s three aunts. It helped a lot. But when it
came to Mona, her family was split on the issue. She
seemed too young. Her grandmother didn’t think
she should do it. Neither did her brother.
“He personally thought I could do it on my own,”
Mona recalls. “He’s like, ‘Go to the gym. Work out.’”
But as intuitive as that solution sounds, it
doesn’t have a great track record. TODAY’s
lifestyle intervention failed to yield statistically
significant results.
“Even with intensive medicinal therapy, diabetes in
teens tends to get worse over time,” says Associate
Surgeon-in-Chief Thomas Inge, MD, PhD, national
primary investigator of Teen-LABS, the first long-
term study of bariatric surgery in adolescents,
published in JAMA Pediatrics in 2014. “That’s what
TODAY showed.”
NEW CONSTELLATIONS
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