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more photosDan Van Epps stands atop bluffs overlooking the Deschutes River after completing a climb . He has become an avid climber since losing more than 200 pounds with the help of bariatric surgery four years ago.
Rob Kerr / The Bulletin
a new look a new life
At age 15, Dan Van Epps weighed 400 pounds. Considered ‘morbidly obese,' the teen was depressed until he was given the OK for bariatric surgery.
By Betsy Q. Cliff / The Bulletin
Published: January 28. 2010 4:00AM PSTDan Van Epps had always been a big boy.
His medical records at age 15 note that he weighed more than 400 pounds and describe him as “morbidly obese.”
At age 8, he wore an adult XXXL size T-shirt. Kids at school gave him a nickname: Big Dan.
Van Epps, now 20, said he was depressed and shy because he felt people would judge him for his size.
“A lot of people look at obese people and think, ‘Oh, this person is gross. I don't want anything to do with them.' And that's the way I felt.”
So when his mother started working at Advanced Specialty Care in Bend, coordinating bariatric surgery, Van Epps became curious. Bariatric surgery is the name for a group of surgeries that change the digestive system, often by shrinking the stomach, and promote dramatic weight loss. After seeing one of the center's patients who had lost a great deal of weight after surgery, Van Epps came to his mother, she said, and asked if he could have the surgery, too.
A child's obesity “is hard on a mom,” said Kathryn Wilson, Van Epps' mother. “I would pray every night that he would just quit growing.”
At age 16, Van Epps had bariatric surgery, receiving a Lap-Band, a plastic band that encircles his stomach, effectively shrinking it. Four years later, he is happy with his surgery and doing well. He says it was nothing short of life-changing.
Whether bariatric surgery is appropriate for adolescents is still debated among physicians. Though the number of bariatric surgeries performed on adolescents has grown in recent years, in 2003, the most recent year for which data are available, it still represented less than 1 percent of all bariatric surgeries nationwide. That year, 771 bariatric procedures were performed on adolescents compared with 105,000 adult surgeries. Some centers will not do the procedure for teenagers due to concerns about long-term health effects and teens' physical and emotional maturity. Others say teens need this option because the risks of obesity are too great and other options too ineffective.
“It's controversial,” said Dr. Robert Sawin, surgeon-in-chief at Seattle Children's Hospital. The hospital does not do the surgery, he said, in large part because of a lack of data about its effect on teens.
“The long-term consequences of that operation are still not well-characterized,” Sawin said. Without data, “there's been some reluctance on the part of many in pediatrics to do an operation of that magnitude that can alter someone's physiology so dramatically.”
In Bend, there have been only a couple of people younger than 18 who have had the surgery, said Dr. Stephen Archer, a surgeon at Advanced Specialty Care who assisted with Van Epps' surgery. “The criteria (for doing the surgery) are stricter and more stringent than for adults,” he said.
Nevertheless, both he and Dr. Marinus Koning, Van Epps' primary surgeon, agreed that Van Epps was a good candidate.
Bigger and bigger
Van Epps started trying diets when he was 10 years old. His mom took him to Jenny Craig, lying about his age, she said, so he would be admitted to the program. In all, he said he tried six or eight diets from ages 10 to 15. Sometimes he would lose a significant amount of weight, but it would always creep back.
“If I started doing the wrong thing or got off just a little bit,” he said, “it would just come back at me.”
Wilson said she was constantly reminded that her son was bigger than other boys. When he was a fifth-grader, he played football. None of the jerseys fit, and the program had to special-order a helmet. During games, other parents would remark about Van Epps: “Look at 89. He's huge.” Wilson said she wanted to retort but didn't know what to say.
Her parenting and his eating were scrutinized. Once, Wilson got a call from Van Epps' elementary school alerting her that her son had potato chips in his lunch. Her other son, who was not obese, also had potato chips that day, she said, but the school took no notice of his lunch.
Van Epps said that as he entered puberty it became particularly hard. “I was getting really depressed and just not having the best time,” he said. “It was super hard. There were certain things I couldn't do, like trips that friends went on. I just didn't have the energy for it.”
By the time he was 15, he was asking for bariatric surgery.
No data
It is likely to be a long time before there is good data on adolescent bariatric surgery.
“Optimum data would be 50 years,” said Dr. Bruce Wolfe, a professor of surgery at Oregon Health & Science University and president-elect of the American Society for Metabolic and Bariatric Surgery. “We don't have anything near that in this population.”
Questions remain, said Wolfe, about whether the weight loss sticks, how the surgery impacts overall health and whether there are complications that may become apparent years after the surgery. There is a national study in progress to try to answer these questions, Wolfe said, though it may be years before anything is known.
The potential risks of surgery, however, must be balanced against the well-known risks of obesity. Obese adolescents very likely become obese adults, with all the health problems that come with it. Obese teens, Wolfe said, often have sleep apnea, report a lower quality of life and lower self-esteem than normal-weight teens. As they grow, they are at a higher risk for a multitude of diseases, including heart disease, Type 2 diabetes and some cancers.
Most other types of interventions fail, Wolfe said. “To achieve long-term success in severe obesity is unusual without surgery.”
A weight-loss tool
Bariatric surgery is somewhat different from other types of surgery in that it is not the fix for a problem but simply an aid to help a patient lose weight.
“We give them a tool,” said Wolfe. “We keep telling them, ‘Your battle with obesity will not end just because of surgery.'”
Bariatric patients lose weight the way other people do, by eating less and following a good diet, though the surgery makes it very uncomfortable to eat large amounts of food. Still, they must commit to a different diet for the rest of their lives and often attend support group meetings to help them deal with the consequences of the surgery.
“It's a very difficult process to go through,” said Archer. “Even adults need lots of support to be able to successfully navigate the post-operative emotional side of changes that occur.”
One of the primary concerns about doing the surgery in teens is that they are not mature enough to make drastic and long-lasting changes to their behaviors. Physicians say teens are notorious for ignoring medical directions.
In both adults and teens, Archer said, the clinic does a psychological evaluation before surgery. In teens, the family is analyzed as well. “There needs to be an understanding on a family level of what a child might need.”
In Van Epps' case, doctors remarked at how much support he received in his family. “It is critically important that kids have a good support system,” wrote Koning in an e-mail message. “This was very clearly the case with Daniel. I had no reservations about operating on him.”
Wilson, Van Epps' mother, made him live on the bariatric diet for 18 months before the surgery, she said, to make sure he could stick to it. He had to eat small portions and cut out junk foods. “He had to prove to us he really wanted it.”
After his surgery, she helped him stick to his diet. She kept a separate cupboard in the house with his food in it and talked to him about nutrition. She checked in with him about how he was feeling.
‘Medium Dan'
After the surgery, Van Epps' weight came off quickly. He lost several pounds each week, he said, stabilizing at about 190 pounds just six months ago. His 6'3” frame now looks almost lanky.
He has noticed other changes, too. He has become more active. He recently took up rock climbing and now goes several times a week. He is pursuing a career in wilderness therapy. Last fall, he spent a month and a half in Wyoming taking a course in wilderness emergency medicine.
Wilson said her son told her there was no way he would have been able to complete the course at his old weight.
Van Epps said he feels more confident and comfortable since surgery. “I feel more open,” he said. “I can walk down the street and talk to anybody now. Before, I couldn't do that.”
Even his nickname is different. A year ago Van Epps' brother changed it. “He said ‘You're not Big Dan anymore, you're Medium Dan.' A lot of people call me that now.”
Betsy Q.
Cliff
can be reached at 541-383-0375 or at bcliff@bendbulletin.com.
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