What's The Best Way To Help Obese Teens?

Bill Clinton recently praised Michelle Obama's anti-obesity initiative, but Time asks, "what do we do for kids who have already gained the weight?" Some of the options — obesity "rehab" or surgery — don't look all that good.

Time's Claire Suddath describes life at Wellspring Academy, a boarding school for obese teens (two students are pictured above). The kids keep food journals, and must adhere to a 1300-calorie-per-day diet (with unlimited fruits and vegetables). Suddath writes,

Every meal at Wellspring is basically a fat-free re-creation of something unhealthy. In their nutrition and cooking classes, kids learn to make mozzarella sticks with fat-free cheese and PB&J sandwiches with imitation peanut butter. They're nowhere near as tasty as the original versions, but the kids seem to like them, and at least they don't feel deprived. "A lot of parents ask me why we don't serve organic health foods," says Craig, "to which I say, Is your kid really going to eat that?"

Maybe if they have no choice. But such a restrictive regimen may encourage bingeing — one student told Suddath about eating "almost everything" on the Taco Bell menu during a trip off campus. And Suddath notes that when kids leave Wellspring, "They have been spoon-fed diet-friendly meals for so long that they are often unsure how to act at birthday parties and pizza nights." Although the school claims a 70% success rate, alum Gina McCorvey gained back half the weight she lost, explaining, "It's way harder than they ever tell you it will be. I felt really guilty making my mom eat the same things as me. And then there were my friends, who always wanted to go to Wendy's." Suddath says other students have had similar experiences — and at $6,250 a month (not covered by insurance), they've paid through the nose for them.

One increasingly popular alternative for teens is weight loss surgery — Dr. Evan Nadler, co-director of the Obesity Institute at Children's National Medical Center, told the Times, "I honestly believe that in 5 to 10 years you'll see as many children getting weight-loss procedures as adults." However, its results are just as uncertain as those of obesity rehab programs, if not more so. Says Dr. Edward Livingston of the University of Texas Southwestern Medical Center,

You don't really know what the outcome is. You talk about the benefit being that it prevents kids from terrible chronic disease later in life. But some of them are going to regain weight. Some of them are going to have long-term complications and we won't find out until later.

Livingston also notes that a third of kids in one study of gastric-band surgery had to have follow-up procedures because of complications. And Dr. Nadler is concerned that as surgeries grow more common, doctors might start performing them without providing the counseling needed to help patients change their eating habits forever. As Suddath points out, programs like Michelle Obama's Let's Move may help prevent obesity in some kids, but for the severely obese, there are still more questions than answers.

Some of the kids at Wellspring suffer health problems, but the best way to make obese kids healthy may not be drastic weight loss. According to the Times, the same study that revealed high rates of complications from gastric banding also found that the surgery resulted in much more weight loss than "an intensive, supervised program for lifestyle change." But those who received lifestyle interventions did see health improvements. For now, teaching healthy habits that are actually sustainable seems like the best way to help obese kids. Unfortunately, "lose weight" continues to be the main advice given to all obese people — even though medicine has yet to arrive at a safe, proven, and effective way to maintain this in the long term. Kids, who are shamed and stigmatized for their weight even more than adults, deserve better.

Does Obesity Rehab Work? [Time]
Surgery For Obese Children? [NYT]
President Clinton Defends Michelle Obama's Infatuation With Fat, Kids' BMI [NY Daily News]