December 18, 2006 — As the national waistline grows larger, more people are choosing to make their stomachs smaller. They’re undergoing bariatric surgery, a category of various operations to reduce the size of the stomach or bypass it entirely. People feel full faster, eat less, and take on fewer calories. REPORTER: A growing proportion of these patients are teenagers, and two prestigious New York City hospitals have recently opened bariatric centers to cater to them. ZITSMAN: This is the stomach right here… REPORTER: Dr. Jeffrey Zitsman stands across from Dr. Dan Davis in the O.R. at New York Presbyterian Childrens Hospital. ZITSMAN: ... and then we’ll work our way gently into the abdominal cavity. . . They’re not looking at the patient, 17-year-old Kimberley Piperato. They’re looking up at video monitors while operating on her laparoscopcally. ZITSMAN: . . . and we want to go way up here, up in this bare area here… REPORTER: The first order of business, Davis says, is to clear some space. DAVIS: We’re going to make a little tunnel to place the band around the stomach . . .that's what we're doing right now... REPORTER: He’s talking about a three-thousand-dollar Lap Band, a patented product by Allergan, a company best known as the maker of Botox. It vaguely resembles one of those rubber Lance Armstrong bracelets – except this one is white, it’s much smaller, it’s made of silicone, and it’s open. Zitsman will close it into a loop shortly. Davis gives the play-by-play. DAVIS: Now we’re going to slip the tubing through the band buckle, just like you’re slipping a belt strap through a buckle, and then lock it. REPORTER: The belt pinches in the top part of the stomach, forming what Zitsman calls an hourglass. Except the top part is much smaller than the bottom part, and the size of the hole can be adjusted. An average stomach holds about a liter’s worth of food and drink. The new pouch is about the size of an egg. Kimberley will only be able to eat a few ounces at a time before she’s full. When she first heard this could be done, she felt she finally found something that could save her from herself. Her step-mother, a physician, supported the move. So did the family’s health insurance. KIMBERLEY: I’ve done Weight Watchers. I’ve done personal trainers at gyms. I’ve done weight-loss camps. Since I was in the fourth grade I’ve done soccer, basketball. I’ve done everything. It just wasn’t happening for me. So, to think I could have surgery to help me along with it, it makes things look better. REPORTER: Parent company Allergan is seeking FDA approval to use Lap Bands for adolescents as young as 14. At the moment, New York Presbyterian Childrens Hospital and NYU Hospital are among the only pilot sites approved to use them on teen-agers. The two city hospitals are focusing on this technique for teens, because while it doesn’t lead to dramatic weight loss as quickly as the more traditional “stomach stapling,” it’s considered much safer. Gastric bypass, as the other procedures are collectively called, can lead to death in as many as 1 out of 50 cases – more than twice the rate for the Lap Band. But its safer track record doesn’t mean it’s without complications. Zitsman says patients can experience nausea or repeated vomiting from over-eating. ZITSMAN: The other major complication is that the band can move. And if it moves out of position, it won’t be effective. REPORTER: It also could cut dig into the stomach and cut off blood. Overall, between 15 and 20 percent of Lap Band patients will need another operation, according to the National Institutes of Health. Still, Zitsman believes that for many obese teens, the benefits outweighs the risks. Kimberley certainly thinks so. KIMBERLEY: I remember the doctors telling me like you know what kind of problems you could have, like if you eat the wrong foods, it could make you throw up. But I think in the end I’d rather have the surgery and deal with whatever problems come with it, because nothing else is working. REPORTER: To get bariatric surgery, you’ve got to jump through a few hoops. You’ve got to prove you tried lots of dieting and exercising, and it didn’t work. You go through psychological screening and commit to rigorous nutritional and fitness regimens after their surgery. The big cut-off, though, is your Body Mass Index. That’s a rough measure of how much fat you have, based on height and weight. Average people have a BMI between 18 and 25. Obesity starts at 30, and 40 is generally the minimum to qualify for surgery. Kimberley is right around 40. She’s 5-feet 9 inches tall and weighs 270 pounds. That makes her large, but not enormous. Even so, she feels she stands out at school, and not in a good way. KIMBERLEY: I went to a small Catholic school. It didn’t really bother me until I went to high school, because my high school’s huge, and it’s all about looks. So that’s when it really started to kick in. Everybody’s skinny. Everybody wants to fit into this and look good for that – and it just wasn’t happening for me. REPORTER: Kimberley’s mom, Janet, agrees. It’s sad but true. Looks matter. And after years of hard work and failure, surgery seemed like a logical – and relatively safe – choice. JANET: I’m a teacher. I walk through schools. The bigger girls do not have the boyfriends like the smaller, more attractive girls do. And that’s an issue in high school. You want what everybody else has! REPORTER: Nutritional expert Paul Ernsberger doesn’t think that’s a good enough reason to go under the knife. The Case Western Reserve University medical school professor thinks the risks are too high for people to think of obesity surgery like they would breast implants or liposuction. ERNSBERGER: It’s become quite popular, because this is a form of cosmetic surgery which is paid for by insurance, and also paid for by the government, by Medicare and Medicaid. Naturally, almost everyone wants to lose weight, and the extremely obese are more desperate than anyone else. REPORTER: But won’t decreasing body weight lower people’s risk for diabetes, heart disease, hypertension and joint problems? Ernsberger says the scientific evidence for surgery improving these conditions is minimal, especially over the long term. He also says there’s little data about long-term side effects, and teen-agers might have these silicone bands around their stomachs for the next 60 years. He thinks doctors should treat illnesses as they emerge – which for adolescents could take quite a while. And there are a lot of alternatives to surgery: ERNSBERGER: Taking a pill or even an injection for diabetes. Taking a pill for blood pressure. Taking a pill to lower cholesterol. These are all much safer than surgery. REPORTER: Zitsman disagrees. He thinks bariatric surgery can help teen-agers lead healthier and more social lives. He, too, would like to see obese patients get control of their weight with better nutrition and exercise, but once they have crossed the threshold into obesity, they are much likelier to get worse than get better. ZITSMAN: The goal is to get them to lose weight. The goal is not to do an operation. The operation is only there if necessary. If there were a foolproof way to get people to lose weight, then there’d be no need for us. But these people are stuck. REPORTER: Back in the O.R., Zitsman is closing up Kimberley’s small laparoscopic incisions. Since this part is more routine, he asks an assistant to turn up the mp3 player that until now has been quietly pumping classic rock into the O.R. After he’s finished, he explains how Kimberley’s real work is just beginning. ZITSMAN: Now’s when it starts. She has to learn how to use it. She has to learn to change her eating habits in such a way she gets the most out of the band [and] changes her exercise habits so that she can lose the weight as well. REPORTER: Kimberley has pledged to come in frequently over the next five years. The average Lap Band patient loses about 50 percent of excess body weight over that period. For Kimberley, that would translate to about 50 pounds. Many patients of the other bariatric surgeries re-gain weight over time, but Lap Bands have only been available in the U.S. for a half-decade, so their long-term record isn’t clear. Zitsman says patients can “outsmart” by eating pudding or drinking milkshakes. Kimberley says that in the past, she’s often surrendered chocolate, pizza and Taco Bell. But with a smaller stomach, she’s confident she’ll resist.