“THIS IS NOT A COSMETIC SURGERY. THIS IS A LIFECHANGING SURGERY.” Robert Cusick, M.D., PEDIATRIC SURGEON
“These aren’t children who are a little overweight. These are children on the extremes of obesity,” Dr. Cusick says. Candidates for bariatric surgery at Children’s must have a BMI of at least 40 or a BMI of 35 with another significant co-morbidity, such as diabetes, obstructive sleep apnea, lipid disorders, pulmonary hypertension or fatty liver disease. To give a little context: ❱❱ A BMI of 18 to 25 is considered “normal” weight. ❱❱ A BMI of 25 to 30 is considered overweight. ❱❱ A BMI of 35 is considered obese. “On average, the children we’ve operated on are around a BMI of 50,” Dr. Cusick says. “Our average ending BMI is in the range of 35. So, they’re still obese after this; they’re just in a much healthier place.” Children’s launched its bariatric surgery program in 2013. As of November 2016, nine patients have undergone bariatric surgery, and six are currently in the evaluation process. “If these kids can achieve great success without surgery, we’d love that. But when they don’t achieve that success, we want to be able to offer bariatric surgery,” Dr. Cusick says. Mackenzi underwent her procedure in October of 2015. It took less than an hour. More than a year later, the results are dramatic. The Nebraska City freshman is down almost 120 pounds, and her activity level is way up. She walks a lot, plays volleyball and throws shotput for the track team. She is no longer on medication for pulmonary hypertension or Type II diabetes, her polycystic ovarian syndrome has improved and her liver is normal. “I knew this was going to be a big deal,” she says. In June, Mackenzi had her trach tube removed after 11 years, which means, in addition to sleeping better, she can actually go underwater when swimming with her
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friends. Mom celebrated the milestone (and Mackenzi’s 14th birthday) with a surprise party, which included lots of friends and a DJ. Mackenzi started coming to Children’s for treatment and monitoring when she was just 6 months old. She has had a total of seven surgeries, including a heart catheterization at age 7. Three years ago, Mackenzi enrolled in the family-centered HEROES program. A multi-pronged effort to get overweight or obese children on the path to proper health, HEROES is the only pediatric weight management program in the region. It combines medical management, nutrition, behavior and fitness classes, behavioral health therapy and consultations with various specialists. “Every day we see severely obese patients with BMIs above 35, 40 or more. For these patients, it is a challenge to decrease BMI to the ‘normal’ levels of an acceptable weight with only our program,” says Cristina Fernandez, M.D., pediatrician and medical director of the HEROES program. “For that reason, bariatric surgery will be an option for some of those patients who are morbidly obese and already learning about a healthy lifestyle with our program.” Children on the bariatric surgery pathway participate in a six-month preparation program before surgery, meeting monthly with the multidisciplinary HEROES team, which includes Dr. Fernandez and Frost, a social worker, psychologist, dietitian and exercise specialist. “It’s a lot of behavioral modification we’re teaching and reinforcing,” Frost says. “We talk about basic eating-healthy-for-life and portion control, making more meals at home instead of going out and not eating for emotional reasons.” During the six months, the team is also gauging a patient’s crucial ability to comply: Are they taking their medicine? Are they showing up for appointments? “After surgery they’re going to be on a special liquid diet for three weeks post-op.