Patient: Megan Muncy is a 14 year old girl who has undergone weight management surgery, and is enrolled in the Nationwide Children’s Hospital’s Healthy Weight & Nutrition Program.
Diagnoses: Extreme obesity associated with multiple co-morbidities, including acanthosis nigricans and insulin resistance, dyslipidemia and chronic intermittent pain in back, ankles and knees.
Referral: Megan was first referred to the Center for Healthy Weight and Nutrition by her primary care physician in 2006. At the time, she was an 11 year old 6th grader, weighing 125 kg (BMI 50 kg/m2). Following medical evaluation, Megan entered the Center’s New U Program, a six month long medical weight management course. Although her weight gain flattened after working with the Center’s medical clinicians, dietitians, recreation therapists and psychologists, in the subsequent year she began again to increase weight, reaching a maximum weight of 160 kg (BMI 67 kg/m2) by year’s end. Enrolled in the bariatric surgery program, Megan’s preparatory evaluation included a cardiac MRI, which revealed mild subendocardial ischemia following an adenosine dilator stress test. She was placed on metoprolol to improve her cardiac function in anticipation of surgery and put through a rigorous diet and exercise regime to increase her fitness level and control her weight.
Procedure: In July of 2009, Megan was admitted for a Roux-en-Y gastric bypass surgery. Her weight at the time of surgery was 154.5 kg and total body fat was 56 percent. Surgeons Marc Michalsky, MD and Stephen Teich, MD created a small gastric pouch which was then connected to the small intestine at a distal point. The gastric remnant and the intestinal limb that was proximal were left out of continuity with the food stream. As a result, the bypass offers weight loss through two complementary mechanisms: early satiety from a restricted gastric volume and malabsorption of calories due to bypassing a segment of intestine.
Outcome: Megan has mastered the bypass diet regimen, eating five to six nutrient-rich and protein-centered small meals per day. Due to the malabsorption that follows bypass, she is required to take a multivitamin and a calcium/Vitamin D tablet daily to supplement her diet. Megan has used walking and stair climbing as her primary exercises, a set of habits that was a struggle for her to ingrain. But now, six months after bypass surgery, Megan weighs 113kg (BMI: 48) with a total body fat of 49 percent. She has steadily lost more than 0.5 lb per day. The metoprolol has been discontinued. Perhaps most importantly, after a lifetime of being teased in school, Megan is now healthy, fit and exuding self-confidence as she faces her high school years.
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