MINNESOTA (AP) — John Simon III was a starving baby, a “chubby” toddler and a chubby toddler, his mother recalls. But by age 14, his weight had skyrocketed to 430 pounds (195 kilograms) and his was a life-threatening medical condition.
Nine months after weight-loss surgery that removed part of his stomach, John has lost about 150 pounds (68 kilograms), improving his health and his hopes for the future.
“It was like a whole new start,” said John, who will start high school in California this fall.
In Minnesota, Edward Kent was diagnosed with hepatic steatosis, or fatty liver disease. The 6-foot, 300-pound high school sophomore began taking Wegovy, an anti-obesity drug, in January — just a month after federal regulators approved it for children ages age 12—and has lost 18 kilograms (40 pounds).
“It’s a serious problem and it’s going to affect him for the rest of his life,” said his mother, Dr. Barbara Van Eeckhout, an obstetrician-gynecologist. “It’s about his health.”
John and Edward are part of a small—but growing—group of young teenagers who are turning to drastic weight-loss treatments in large numbers, including body-modifying surgeries and new metabolism-altering drugs. Critics urge caution in intervening at such young ages, but children and their parents say intense — and often expensive — measures are necessary options after years of ineffective diet and exercise programs.
“John has tried so hard,” says his mother, Karen Tillman, a 46-year-old accountant. “It’s not because he didn’t try. It just kept getting harder.”
80% of overweight adolescents carry it over into adulthood, with potentially dire consequences for their health and longevity. Obesity was first classified as a complex chronic disease a decade ago by the American Medical Association, but meaningful treatments have been long overdue, says Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine. Pediatric Obesity) at the University of Minnesota.
“It’s a biologically driven disease. It’s not a behavioral disease,” Kelly stresses. “We have to treat her early. Don’t wait until later in life because it’s too late.”
In January, the American Academy of Pediatrics (AAP) issued guidelines that require weighing anti-obesity drugs for children as young as 12 and surgery for children as young as 13. The recommendations sparked immediate controversy.
Advocacy group Mental Health America called them “dangerous” and “daunting,” claiming they would increase eating disorders and perpetuate harmful weight stigma. Some on social media accused doctors and parents of taking the easy way out, blaming things like junk food or video games for the problem, or even accused parents of “child abuse.”
Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital, cautioned that “justified enthusiasm” for new weight-loss drugs should not overshadow non-drug options.
“Especially for children, diet and exercise should be paramount in the prevention and treatment of obesity,” he wrote in the Journal of the American Medical Association.
But medical experts who treat children with severe obesity say the research is clear: Diet and exercise alone aren’t enough. More than 240 diseases are associated with being overweight — including liver problems, diabetes and inflammation — and the signs come early, says Dr. Janey Pratt, the Stanford University surgeon who operated on John Simon.
“It’s already affecting the major organs when they arrive with me,” Pratt stressed. “You’re dealing with a train heading off a cliff.”
Early in elementary school, John suffered from joint pain, shortness of breath, and sleep apnea so severe that, at age 12, he needed coffee to stay awake. He developed anxiety from the daily bullying at school and was hospitalized for two months for post-traumatic stress disorder when he was in the sixth grade.
“They call me names, they hit me, they push me, everything,” John says. “There were many difficulties that I had to go through.”
After trying diets and exercise, she lost up to 40 pounds (18 kilograms), but intense food cravings meant the weight kept coming back, or worse, gaining. By the time John met Dr. Callum Rowe, a pediatrics resident in a public health clinic at Children’s Hospital Los Angeles, John had a body mass index of 75. It was well above the charts that measure body mass. body mass index which is considered a flawed but widely used tool by doctors to detect obesity.
John, who has a shy smile and a soft voice, called for help. He explained that he wanted to go on a “wellness journey,” Rowe recalls.
“I found that very insightful for a 13-year-old boy. He’s an old soul to have that level of knowledge about what I can do to change my situation,” adds Rowe, who referred John to the Stanford Medicine Children’s Health weight loss program. (Stanford Children’s Health and Medicine).
That meant moving to Palo Alto, 350 miles (565 kilometers) north, but Karen Tillman said she was willing to do anything.
“His weight was increasing every minute,” he adds.
Applications for Stanford’s surgery program have doubled since the publication of the AAP guidelines, Pratt said. It is one of the busiest sites in the United States, performing more than 50 of the 2,000 registered pediatric weight-loss surgeries each year.
John was lucky: Less than 1% of children who qualify for metabolic surgery have the procedure. Doctors may be reluctant to refer them and families don’t know it’s an option or that it’s so expensive, experts say. Costs are more than $20,000 and can be as high as $100,000.
John’s surgery was covered by Medi-Cal, California’s Medicaid program, which paid for 47 operations for children ages 11 to 17 last year, according to state health records. Throughout the United States, Medicaid coverage of weight-loss surgeries for children varies significantly by state.
On average, children who have weight-loss surgery lose between a quarter and a third of their body weight, studies show. But about 25% of children regain the pounds and need further treatment, Pratt says. With Wegovy, adolescents lost around 16% of their body mass over almost 16 months in a clinical trial. Those who take anti-obesity drugs — requests for which have skyrocketed at Stanford and across the country — regain weight once they stop taking them, research shows. Some who take the drugs see potentially serious side effects, such as gallstones and inflammation of the pancreas.
Edward Kent has responded well to the obesity drug, which has turned off his voracious appetite “like a light switch,” his mother says. On a recent exam, Edward’s liver function had returned to normal.
John Simon has lost around 35% of his body weight in less than a year. His liver function and insulin resistance have improved, Pratt says. His arthritis is receding, he sleeps better and moves more easily.
John’s struggle still extends beyond conquering his own cravings and improving his health. The bully attacks got so bad at his school that teachers assigned him to walk with him between classes.
“He’s going to come out of this with some kind of hurt,” lamented John’s pastor, Charles Griffin III, of DaySpring Christian Church. “We pray that when he gets out of this, he’ll be stronger.”
John finished his junior year at his high school this month, where administrators did not comment on steps they took to address bullying. Next year he will study at a subsidized private secondary school, which will be smaller and—his mother hopes—more compassionate.
John, now 15, is focused on the future. He has learned to cook healthy meals, such as a recent dinner of sautéed shrimp and collard greens. He works out at a local gym, according to his pedometer he walks 18,000 steps every day and hopes to study hard to land his dream job as an automotive engineer.
“I just want to live a happy and healthy life,” she says. “Without the pain. And just without the weight.”
