Desperate Measures

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.

Gastric-bypass surgery may work for some youngsters, but it is not going to stop the epidemic of teenage obesity. Sooner or later, some dramatic changes are going to have to be made in how and what we eat.