When diets don't work, children turn to surgery

Today, 19-year-old Daniel Soderberg is a trim 166 pounds. His body is limber and strong.

"Whew. I cleared that whole thing," he said after sailing over a curb on his skateboard. "That's nice."

Watching Daniel skate, it's hard to believe that when he was 12 he weighed 329 pounds. That's three times what someone his height and age should weigh.

Minnesota has the lowest rate of overweight and obese children in the country. But there is cause for concern.

More than 23 percent of the state's children carry too much weight on their young, developing bodies. Some are so fat that they are considered extremely obese -- putting them at substantial risk of developing devastating diseases or dying prematurely.

For many, the path to obesity begins early.

Even as a toddler, Daniel was big. By the time he was two and a half, he could no longer squeeze into his car seat, said his father, Brian Soderberg. Still, Soderberg and his wife, Denise Engstrom, weren't alarmed.

"Because I was big. She was big. My mom was big," Soderberg said. "We were all heavy set. So really I never gave it any thought."

Daniel's weight gain eventually became impossible to ignore.

"They put me on a lot of diets. They really did," he said of his parents. "Like every diet there was, I was on."

But diets didn't work. Daniel's school photos -- at age 6, 8 and 10 -- document his transformation from a chubby first grader to a dangerously overweight adolescent.

"You can see how he was gaining weight even though we were trying to maintain a diet," his father said. "I mean, we couldn't keep the weight off."

By age 11, Daniel was suffering from back and neck pain. Then he developed severe headaches. His father thought he was faking his illness to get out of school.

"One day I asked him for the remote control off the table, and he physically reached around the table like he couldn't see it -- and it was right there," Soderberg recalled. "It was the only thing on the table. And that's when it occurred to me that there might be something going on -- that he can't see."

Daniel's huge weight gain put enormous pressure on his optic nerves, and that was making him blind. The condition he had is called pseudo tumor cerebri. It's associated with obesity -- but usually it doesn't occur until adulthood.

To relieve the pressure on his eyes, Daniel's doctors cut slits in the nerves. But it wasn't enough. They said he needed to lose weight quickly to save his sight.

They recommended a gastric bypass -- a procedure in which doctors bypass the stomach and create a much smaller pouch to capture food. The procedure essentially forces the patient to eat dramatically less food.

At 12, Daniel became probably the youngest person in the world at the time to receive a gastric bypass. His surgeon at the University of Minnesota, Dr. Sayeed Ikramuddin, didn't take the matter lightly.

"We wondered, will you grow after something like this?" Ikramuddin recalled.

Because his patient was going blind, the surgery was a "no brainer," Ikramuddin said.

Daniel's gastric bypass was a success. He lost more than 170 pounds and regained most of his eye sight. He also grew to 5 feet, 11 inches -- taller than both of his parents. A year after his surgery, Brian and Denise had gastric bypasses. Denise lost 110 pounds and Brian lost 165 pounds.

Today, gastric bypass surgery and another procedure called gastric banding are becoming more common among children. The University of Minnesota has done more than 100 in the past few years.

Ikramuddin has treated children who weighed twice as much as Daniel. But it was almost too late for those kids, because they didn't lose enough weight to make a meaningful difference in their health, he said.

That's because the weight-losing effects of gastric procedures only last from nine months to a year and a half. After that, it's very difficult to shed extra pounds.

The university's obese patient population appears to mirror trends nationally. According to a new study in the Journal of Pediatrics, the number of extremely obese children is climbing. Researchers looked at the health records of 710,000 kids in southern California and found that 7.3 percent of boys and 5.5 percent of girls are extremely obese.

Extreme obesity is when a child rates more than 1.2 times the 95th percentile on a growth chart. That's a measure of the child's size compared to other children of the same sex and age.

With the rate of extremely obese kids climbing, Ikramuddin said, pediatricians and family doctors should act more quickly.

"Once someone who's between the ages of 12 to 17 crosses 250 pounds, they need to be seen by a surgeon, if anything just to sort of scare them as to what the alternative is," he said.

Surgery is not a cure for the obesity epidemic. The cure is making sure kids never reach 250 pounds or more in the first place.

Along with a proper diet, exercise is key. That's what dietitian Christine Melko tried to show a group of children, ages 7 to 12, as she demonstrated the proper way to turn on a pedometer. The kids seemed excited to use their new step-counting devices.

"You just want to hold the button down so it zeros it, and close it up, because it won't count if it's open like that," Melko said.

The children were at a weight management clinic because they have been diagnosed as obese by Dr. Betsy Schwartz. Schwartz treats kids who are already showing signs of illness related to their excess weight. She organized the pilot project at Park Nicollet Clinic in St. Louis Park, where she works.

"We're seeing a huge number of type 2 diabetes, which we used to not see at all in children," Schwartz said. "We usually only see it in the older kids. But even in the younger kids we're seeing signs of early abnormalities such as insulin resistance, high insulin levels that put kids at risk for later developing diabetes."

Diabetes isn't the only disease plaguing some of Schwartz's young, overweight patients. She treats kids with high blood pressure, high cholesterol and a condition called fatty liver disease -- an accumulation of fat in the liver that can cause inflammation and scarring. In its most severe form it can cause liver failure.

All of these diseases are preventable. But overweight children will have to completely change their lifestyles to fix the problems caused by their excess weight.

On a recent Thursday night, Melko took the class on a tour of the Byerly's grocery store across the street from the clinic. She started her mini-course in nutrition in the deli section.

"When we're looking at these salads, what we want to do is we want to focus on the ones that don't have a lot of mayonnaise," she said. "And when it comes to serving sizes for these salads, we're looking at about a half a cup to two-thirds of a cup. So it's not a lot."

Some of the parents in the group nodded and sighed as Melko continued delivering bad news about some of their favorite foods.

Angie Larson of Bloomington felt a little overwhelmed.

"Everything that they're saying is bad, is what we have in the house," Larson said. "You know the 2% milk, the white bread and all of the treats and snacks. Nothing low-fat."

Larson's 9-year-old daughter April has high cholesterol. It hasn't reached the danger zone yet, but her parents know they need to do something about it now.

April is motivated too. She's keenly aware that she's overweight. Because of her weight, April avoids close-fitting clothing. She wears fluffy shirts. But sometimes she wishes she had other choices.

"My sister, she's really skinny and she wears skin tight," April said.

April's dad, Dave Larson, said he's not sure why his youngest daughter is struggling with weight more than the rest of the family. But as a part of his role in the program, he has given up his nightly ice cream indulgence for April's sake.

"When it comes right down to it, that's where you gotta look in the mirror and say, she's not getting it herself," Larson said. "That's something that you're providing for her and you need to address it."

In just seven weeks on the program, Larson has lost 7 pounds. His daughter has lost two pounds and her cholesterol already is lower.

But changing one's lifestyle is hard work -- and Larson knows it will be especially challenging over time when his family might not feel as motivated as they are now.

The health experts running this project know that's true, but they don't want anyone in the group getting hung up on negative thoughts. They believe success can be measured by lots of little improvements, made one meal at a time.

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Minnesota Idea Open

Minnesota Public Radio News reported this story as part of a project being directed by the Minnesota Community Foundation. Along with other partners, the foundation has launched a contest -- the Minnesota Idea Open -- that asks Minnesotans to offer ideas to help combat obesity in their communities. Implementation of the winning idea is funded with a cash award. April 9 is the last day to submit ideas. For more information visit: www.mnideaopen.org

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