Obese teens heading for bariatric surgery already show kidney damage

[southernlady]

Obese teens heading for bariatric surgery already show kidney damage

By: BRUCE JANCIN

05/16/14

LAS VEGAS – Seventeen percent of severely obese adolescents slated for bariatric surgery in the Teen-Longitudinal Assessment of Bariatric Surgery study already had micro- or macroalbuminuria.

At a meeting sponsored by the National Kidney Foundation, Dr. Nianzhou Xiao said that future reports from the ongoing Teen-LABS study will provide the answer to a critical question: Is this worrisome loss of kidney function so early in life reversible via surgical weight loss?

Dr. Xiao presented a cross-sectional baseline report on 242 severely obese adolescents with a median body mass index of 50.5 kg/m2. Fourteen percent had microalbuminuria and another 3.1% had macroalbuminuria. Although the group’s mean estimated glomerular filtration rate was 107.6 mL/min per 1.73 m2, 3% of the teens had an eGFR below 60 mL/min 1.73 m2, which is the definition of stage 3 chronic kidney disease.

In addition, 45% of the teens were hypertensive before surgery, 74% were dyslipidemic, and 13.6% had diabetes. The group’s median serum ferritin was 37 mcg/L, noted Dr. Xiao of Cincinnati Children’s Hospital Medical Center.

Multivariate analysis identified two independent risk factors for an elevated albumin to creatinine ratio: female gender, with an associated 2.34-fold increased risk, and elevated serum ferritin. For every 10 mcg/L of ferritin, the likelihood of an elevated albumin-to-creatinine ratio rose by 7%.

An estimated 4%-6% of U.S. children and adolescents are severely obese, defined as a body mass index of 35 kg/m2 or more or a body weight above the 120th percentile. The ongoing Teen-LABS study is the most comprehensive examination of kidney status in severely obese adolescents undergoing bariatric surgery.

Teen-LABS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Xiao reported having no financial conflicts.

 

[Larra]

This is really scary!

One of the things I sometimes have trouble getting across to people is that even if they feel ok (so far) and their labs are normal (so far), damage is already being done to their internal organs. It just hasn't shown up yet or standard tests. They aren't diabetic - yet. Their kidneys haven't failed - yet. And so on. Granted these are very heavy teens, but even so, for so much damage to be present at such a young age is really scary.

 

[southernlady]

This is really scary!

One of the things I sometimes have trouble getting across to people is that even if they feel ok (so far) and their labs are normal (so far), damage is already being done to their internal organs. It just hasn't shown up yet or standard tests. They aren't diabetic - yet. Their kidneys haven't failed - yet. And so on. Granted these are very heavy teens, but even so, for so much damage to be present at such a young age is really scary.

Yeah, a good friend of mine's daughters are both very obese. Granted they are no longer teens but they have been obese since I have known them and they were both under 12 then.

One of them is borderline diabetic and on cholesterol meds now and she isn't 25 yet. The other, younger one is headed that way. And yet they all have known about the DS as an option since I started my journey almost 4 years ago (back in June 2010) and they have seen how I eat. When I was first looking into this, my good friend would get me to explain all of what II was doing. The girls would ask questions so they ARE familiar to the process but I didn't ever suggest it was their route. I'm hoping that my example will stick but they aren't ready yet. I am around if they ever do decide to take the bull by the horns but I don't say anything. I just hope it's not before too much damage is done.

 

[Ladytaz]

I am dealing with this in my own life. My youngest daughter is obese and on the fast track for morbid obesity. And there is nothing I can do. I know I set a horrible example for her for many years but I have 5 kids and she is the only one who is obese. She is a hard core food addict. Of my type and I really consider myself as a die hard food addict. In remission now thank god.
I know I helped her some because as soon as she turned 18 and had a job I told her I was no longer responsible for feeding her. I was a weenie and fed her up until then and when she became an adult I resigned from the job. And in less then a year of being fully responsible for her eating she has packed on at least 30 or more pounds. It is very noticeable and she is miserable.
We've talked and she is adamant that she will never have WLS and I agree it wouldn't be a good idea from her until she addresses her eating issues. She knows she has dysfunctional eating but does not want to stop. What she wants is to be able to eat what she wants and not be fat. Don't we all, lol.
Anyway, at 18 she is already having health issues. She just spent the night at the ER because of constipation, because of her poor eating. She has been the the ER several times in the last year, all related to stomach issues, all that can be directly linked to her eating. She was also diagnosed with a fatty liver at 14, as well as elevated liver enzymes. I told her it will only get worse.
At this age it will mostly be feeling unwell physically, not to mention the social problems. As she gets older the problems will increase. It is really like living with a practicing alcoholic. In fact, she doesn't touch alcohol or drugs because food is the drug of her choice. Her checking account is linked to mine and every transaction on there is for food, restaurants and fast food places. And there isn't a damn thing I can do about it. I have even taken her to Overeaters Anonymous and she agreed that she was a compulsive overeater, but like I said, has no desire to stop, only to have the consequences stop.

 

[Larra]

Ladytaz, I'm so sorry you are going through this. You are right, there is nothing you can do, anymore than you could personally stop an alcoholic from drinking. The best you can do is to love her no matter what her weight is, as I'm sure you do, to not enable her, which you have done by making her responsible for her food choices and paying for them, and by being available to discuss surgical or nonsurgical weight loss with her whenever she becomes ready for that discussion.
We all want to help. We even see strangers who are obviously struggling with their obesity and wish we could help them, let alone our loved ones. But there is only so much we can do. I hope that the medical community will acknowledge that earlier intervention, and stronger intervention, is needed, as prevention really is the way to go, and working with young children on diet and exercise can make a real difference. And for those for whom the prevention ship has sailed, we need to recognize that 18, and sometimes younger, is not too young for bariatric surgery, provided the patient is sufficiently responsible and emotionally ready for it.

 

[Ladytaz]

I would support her 100% if she wanted a sleeve but she isn't interested. She doesn't want to not be able to eat whatever she wants in the amounts she wants. Like I said, she just doesn't want to gain weight from her choices.
At least it seems the world is a little kinder to overweight kids, at least in her case as compared to when I was growing up. Sadly, there are so many kids who are heavy that it no longer sticks out as much as it used to. She has many other friends who are like her and the guys in her crowd really do find the curvier girls more attractive so she hasn't suffered socially at least. She hasn't been ostracized or rejected because of her weight like I felt like I was at her age. But she still feels bad about herself. I tried to find some kind of treatment for her but all her insurance will pay for is DBT and she isn't interested in that even though I think it would benefit her but probably not with her eating issues.

 

[JackieOnLine]

that must be hard to watch, Lady Tazz - what does DBT mean?

 

[Ladytaz]

http://en.wikipedia.org/wiki/Dialectical_behavior_therapy
Dialectical behavior therapy (DBT) is a therapy designed to help people change patterns of behavior that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior. DBT assumes that people are doing the best that they can, but either are lacking the skills or are influenced by positive or negative reinforcement that interfere with one’s functioning.

I actually took it. It was a course of several classes with a group of others. I have found it very helpful but I don't see how it would benefit my daughter. I suppose the group she would be in would be with others who have eating issues so it would be a support group but while it was helpful for me it didn't do diddly about my eating. I took it about 15 years ago in regards to my depression and it didn't really help that at the time but it is still not a bad thing.