Global Courant
John Simon III was a hungry baby, a “fat” toddler and a chubby little boy, his mother said. But by age 14, his weight had increased to 430 pounds and was a life-threatening medical condition.
Nine months after undergoing weight loss surgery to remove part of his stomach, John has lost about 300 pounds, benefiting his health and his hopes for the future.
“It was like a whole new start,” says John, who will be attending high school in California this fall.
In Minnesota, Edward Kent was diagnosed with fatty liver disease. The six-foot-tall high school sophomore began taking the obesity drug Wegovy in January — just a month after federal regulators approved it for kids ages 12 and older — and has lost 40 pounds.
“It’s a huge problem and it will affect him for the rest of his life,” says his mother, Dr. Barbara Van Eeckhout, an obstetrician-gynaecologist. “This is about his health.”
John and Edward are among a small but growing group of young teens who are turning to treatments such as body-altering surgery and new drugs that rewire the metabolism to lose large amounts of weight. Critics urge caution in intervening so early, but the children and their parents say the aggressive — and often expensive — measures are necessary options after years of ineffective diet and exercise programs.
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“John tried with all his might,” said his mother, Karen Tillman, 46, an accountant. “It’s not because he couldn’t try. It got harder and harder.”
Eighty percent of overweight adolescents carry it into adulthood, with potentially serious consequences for their health and longevity. Obesity was first classified as a complex, chronic disease by the American Medical Association a decade ago, but meaningful treatments have lagged far behind, says Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.
“It’s a biologically driven disease. It’s not a behavioral disease,” Kelly said. “We have to start early. Don’t wait until later in life, because it’s too late.”
In January, the American Academy of Pediatrics issued guidelines advocating considering anti-obesity medications for children as young as 12 and surgery for children as young as 13. The recommendations were immediately controversial.
Mental Health America, an advocacy group, called them “dangerous” and “disheartening,” saying they would exacerbate eating disorders and perpetuate a harmful stigma related to weight. Some on social media accused doctors and parents of taking the easy way out, blaming things like junk food or video games — or accusing parents of “child abuse.”
Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital, cautioned that the “justifiable excitement” about new weight loss drugs shouldn’t overshadow nondrug options.
“Especially for children, diet and exercise should remain at the forefront of obesity prevention and treatment,” he wrote in JAMA.
But medical experts who treat children with severe obesity say research is clear: diet and exercise alone are not enough. More than 240 diseases are associated with obesity — including liver problems, diabetes and inflammation — and the signs show up early, said Dr. Janey Pratt, a surgeon at Stanford University who operated on John Simon.
“It’s already affected major organs by the time they get to me,” Pratt said. “You’re dealing with a train going over a cliff.”
From elementary school, John struggled with joint pain, shortness of breath and sleep apnea that were so severe that by age 12 he needed coffee to stay awake. He developed anxiety brought on by daily bullying at school and was hospitalized for two months as a sixth grader with post-traumatic stress disorder.
“They scold me, hit me, push me, all of the above,” John said. “It was a lot of hardships I had to endure.”
He tried dieting and exercise and lost up to 40 pounds. But intense food cravings meant the weight always came back — plus more. By the time John met Dr. Callum Rowe, a pediatrician at a public health clinic at Children’s Hospital, Los Angeles, John had a body mass index of 75. It was way off the charts that measure body-mass index, or BMI . , which is considered a flawed tool but widely used by doctors to screen for obesity.
John Simon, a teenager who underwent bariatric surgery in 2022, trains with his trainer Chris Robles in Los Angeles on March 13, 2023. (AP Photo/Jae C. Hong)
John, who has a shy smile and a soft voice, asked for help. He said he wanted to go on a “journey to wellness,” Rowe recalled.
“I thought that was very profound for a 13-year-old. He’s an old soul to have so much insight into what I can do to change my situation?” said Rowe, who referred John to the Stanford Medicine Children’s Health weight-loss program.
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It meant traveling to Palo Alto, 350 miles north, but Karen Tillman said she was willing to do anything.
“His weight was going up by the minute,” she said.
Applications for the Stanford surgery program have doubled since the release of the AAP guidelines, Pratt said. It is one of the busiest locations in the US, where more than 50 of the 2,000 pediatric weight-loss surgeries are performed each year.
John was lucky; less than 1% of children eligible for metabolic surgery go through with the procedure. Doctors can be reluctant to refer, and families don’t know it’s an option or costs too much, experts say. Costs range up to $20,000 and can go up to $100,000.
John’s surgery was covered by Medi-Cal, California’s Medicaid program, which paid for 47 surgeries last year for children ages 11 to 17, according to state medical records. In the US, Medicaid coverage of weight-loss surgery for children varies significantly by state.
On average, children who undergo weight-loss surgery lose about a quarter to a third of their body weight, studies show. But about 25% of kids gain back the pounds and need further treatment, Pratt said.
With Wegovy, adolescents lost about 16% of their body weight over almost 16 months in a clinical trial. Those on obesity drugs — whose applications have skyrocketed at Stanford and across the country — gain weight again once they stop, research shows. Some who take the drugs may see serious side effects such as gallstones and inflammation of the pancreas.
Edward Kent has responded well to the obesity medication, which turned off his voracious appetite “like a light switch,” his mother said. On a recent examination, Edward’s liver function had returned to normal.
John Simon has lost about 35% of his body weight in less than a year. His liver function and insulin resistance have both improved, Pratt said. His arthritis is decreasing. He sleeps better and moves easier.
John’s struggle still goes beyond overcoming cravings and improving his health. Bullying attacks got so bad at his high school that teachers were ordered to walk him between classes.
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“He’s going to come out in some form of pain,” said John’s pastor, Charles Griffin III of DaySpring Christian Church. “The prayer is that when he comes out of this, he will be stronger.”
John graduated from his high school this month, where officials declined to comment on the steps they’ve taken to deal with the bullying. He will be attending a charter high school next year that will be smaller and, his mother hopes, more compassionate.
John, now 15, is focused on the future. He has learned to prepare healthy meals, such as a recent dinner of fried shrimp and Swiss chard. He works out at a local gym, puts 18,000 steps on his pedometer 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,” he said. “Without the pain. And just without the weight.”
