Health: Desperate Measures

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On the other hand, it's hard not to sympathize with the plight of these youngsters. Many have suffered with obesity their entire life. "I just want to be able to go to a theme park and fit into any ride I want," says Paris Conley, 16, who is 5 ft. 7 in. and weighs 335 lbs.

"I would rather die on the operating table than go through life like this," Lauren Lebow remembers telling her mother. After surgery, the 5-ft. 3-in. Lebow shrank from 285 lbs. to 165 lbs.

Proponents of gastric bypass agree that it's not for everyone. "This is a treatment of last resort," says Inge. "The bar should be higher for adolescents than it is for adults." At Cincinnati Children's, that means prospective candidates must be at least 130 lbs. overweight--typical weights are 350 lbs. to 450 lbs.--or suffering from Type 2 diabetes or severe breathing problems. The cost of the operation runs from $25,000 to $40,000, and kids often miss a month of school during recovery. Patients must also participate in the hospital's nutrition, exercise and counseling programs. At Texas Children's Hospital in Houston, which has decided to launch a gastric-bypass program, patients must also agree to 10 years of follow-up visits.

Why the rush? critics ask. Dr. Diana Farmer, chief of pediatric surgery at the University of California San Francisco Children's Hospital, is among those who take a skeptical view. "Look, kids are not dropping dead at age 19 from obesity," she says. "Even in obese patients who have diabetes or sleep apnea, there are treatments." There is still time, Farmer and others insist, to work on losing weight the old-fashioned way through diet and exercise, which they concede is hard but not impossible. Then if folks are still obese when they reach adulthood, at least they are better prepared to decide whether to undergo such radical surgery.

They will have more choices if they wait. One alternative that's available to adults but not teenagers is the Lap-Band, a strip of silicone that surgeons place around the stomach to constrict it. Although the results have not been as consistently dramatic as with gastric bypass, the Lap-Band procedure is safer, easily reversible and less expensive (from $12,000 to $20,000). For the two years that Lap-Band has been available in the U.S., its developers have concentrated on the adult market. Now they are going to try to get approval from the Food and Drug Administration to use it in adolescent cases.

But there's a broader issue at stake. Even if gastric-bypass surgery were as safe as getting your wisdom teeth pulled, you would still have to ask yourself why so many American teenagers are obese enough to consider it. Clearly we Americans, as a group, eat too much and move too little. Sure, our parents, our genes and our self-control play roles. But so do the presence of candy and soda machines in schools, cutbacks in physical education and ever expanding portion sizes in restaurants. If you tried to design an environment that would promote obesity in the greatest number of people in the shortest period, you could hardly do better than American pop culture in the past 20 years.