Robotics power new weight loss surgery option for adolescents at MUSC Health

There was a time when bodybuilder James Tuttle, 21, wasn’t expected to live this long. “Basically, honestly, when I went to the doctor one day, I was very obese. The doctor said that I would be dead by 20.”

Weight loss surgery at MUSC Health’s Adolescent Bariatric Surgery Program prevented that grim outcome. Today, Tuttle is happy and healthy – and speaking out to encourage other overweight teenagers to get help. 

“Don't hesitate, because it changes your life. I want people to have the same opportunity that I have. It's really life-changing. And I want them to see that having a healthier lifestyle can make you more energetic. It can make you smarter. It can make you happier. It can make you feel better.”

Pediatric bariatric surgeon Aaron Lesher, M.D., is the doctor who helped Tuttle make that change. In a country where one in five adolescents is obese, weight loss surgery for teenagers is an increasingly popular solution to what can be a life-threatening problem. 

 

Lesher said MUSC Health has the only program in the state that’s accredited to take care of adolescents by meeting the standards of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. It’s been growing as the demand for weight loss operations increases.

Surgery may sound like a surprising choice for a teenager, but Lesher said it’s been shown to be safe and effective. “Several high-quality studies were done looking at weight loss surgery in adolescents, and the results were quite promising. I began to offer this treatment around eight years ago and have begun to see larger and larger patients.”

His team uses body mass index to determine whether an adolescent is a good candidate for surgery. “A normal BMI is 20. Overweight is between 25 to 30. Obese is 30 to 40. And morbid obesity starts at 40. So a BMI of 40 is the level at which you qualify for surgery for most insurances and bariatric practices, although there are some exceptions.”

As more adolescents seek weight loss surgery, Lesher said the technology is getting better and better. He has been offering robotic bariatric surgery at MUSC Health for about a year, using a machine called Da Vinci. MUSC Health is the only place offering such surgery for adolescents in South Carolina.

 

“With traditional laparoscopy, especially in patients with very high BMIs, you're really torquing on the abdominal wall. This can generate more pain after surgery. But with Da Vinci, it's all happening inside. It's not happening at the level of the abdominal wall. So I have noticed that they have less pain post-surgery. This technology also offers better visualization of the anatomy and the ability to control more tools during the surgery.”

But Lesher said he’s glad surgery isn’t the only option for weight loss. People struggling with obesity need as many choices as possible. “The newer weight loss drugs are quite effective. We are looking at between 10% and 20% of your total body weight loss.”

Weight loss surgery, on the other hand, tends to lead to about a 25% to 30% loss. 

It’s important to note that a problem with the newer weight loss drugs for teenagers, Lesher said, is that they aren’t often covered by insurance unless the patients have diabetes. “And most of the teens I see don't have insulin-dependent diabetes. Most of the adolescents need significant weight loss to improve quality of life. Some of my patients have obesity-related comorbidities like prehypertension; some of them are prediabetic, but those drugs are not covered for those problems.”

The drugs can also cost hundreds of dollars per month, Lesher said. “At this point, the cost of doing a minimally invasive surgery that is very effective and requires a minimal hospital stay is lower than taking a GLP-1 inhibitor for a prolonged period of time.”

 

Lesher said there are two main kinds of weight loss surgery offered to teens. “One is called sleeve gastrectomy, and the other is called the gastric bypass. With the sleeve, we take out about 75% of the capacity of the stomach. So you end up with a narrow, banana-shaped stomach. That restricts the amount of food that it takes for you to feel full.”

In gastric bypass surgery, the surgeon makes a pouch in the stomach and connects it to the intestine. Food then bypasses most of the stomach, reducing how much a person can eat.

 

Lesher said sleeve gastrectomy has become the most popular surgery for younger patients, accounting for about 80% of the procedures done on this group in the U.S. It has a lower risk of long-term complications, and patients who have had the sleeve and later regain weight still have a good second option, even years later. “And a lot of the micronutrient deficiencies, anemias, vitamin deficiencies that you get with the bypass, you don't see those as much with the sleeves.”

Lesher, who performs 20 to 30 adolescent bariatric procedures per year, said about 1% of patients who have the sleeve have a problem called a sleeve leak that requires specialized care. “I really counsel them a lot about what to do if that happens,” he said. 

“Even though this is a rare complication, it is important to have advanced proceduralists who treat these complications. The MUSC Bariatric Surgery Program is the only place in the state that offers the full complement of services needed to take care of these vulnerable patients.”

One former patient, Tuttle, feels a lot less vulnerable than he used to. He credits mental fortitude and faith for his success following surgery. 

Eating habits that were once out of control are now carefully monitored. “I'm trying to pro bodybuild, and I eat the same exact thing every day,” Tuttle said.

“So I eat ground beef, chicken, rice and spinach. When it comes to a sweet treat, I would always be addicted to having something good to eat. But now, I kind of just don't think about it like that. It's more of like fuel because I found something more fun to chase – bodybuilding. So a better habit, basically."

A better habit and a better life, Tuttle said. “It's an all-new experience for me. And honestly, it's a new life. I can't even remember myself five, six years ago because so much has changed.”