Posted at 5:00 am
“I can’t wait, but I know it won’t be an easy fix. At the end of the line, young Vincent Cournoyer, 18, has a fever. He has suffered from severe obesity since he was a teenager and will undergo bariatric surgery in the coming months, aimed at slimming him to improve his health.
At the age of 12, Vincent developed an eating disorder that caused him to gain weight rapidly. “If there were two boxes of cookies, I would eat them all and cry at the same time because I feel bad,” he says. These fits drove him to eat whatever he had on hand. “It wasn’t a pretty sight. »
The teenager would then force himself to vomit or exercise excessively to burn off the calories he had just eaten. “I was addicted to the Just Dance game because after my fits I danced the whole time, for two or three hours,” he says. He also hid food “just in case [il avait] a need to eat,” he says.
Quebec offers youth a route to bariatric intervention, which is considered an effective intervention for some patients. The majority of teenagers who undergo bariatric surgery have gastric sleeve surgery. In this procedure, about two-thirds of the stomach is removed, which is reduced to a narrow tube of about 150-200 ml. Since 2015, 22 minors have undergone the operation, according to data from the Régie de l’assurance maladie du Québec obtained by La Presse.
Vincent Cournoyer is one of the young Quebecers who will benefit from the intervention. At 16 he was approaching 300 pounds.
It was hard to see my body changing. I saw all the stretch marks on my body. When I was a child, I was bullied because of my weight.
Vincent Cournoyer
Despite follow-up visits to a psychologist to treat her eating disorder, the number on the scale continued to rise. Her mother contacted the Center of Excellence for Severe Obesity in Adolescents at Montreal Children’s Hospital. More than 50 young people are currently waiting to be admitted.
When he was admitted last April after more than a year of waiting, he was cared for by an impressive team consisting of a doctor, a nutritionist, a psychologist, a social worker and a kinesiologist. His eating disorder slowly resolved. “I’m doing much better, but I’m not perfect yet, that’s for sure,” he says.
Over the past few months, Vincent’s weight has stabilized at 300 pounds. Because of his health condition, the doctors suggested that he opt for bariatric surgery.
Unfortunately at the moment I have fat in my liver which can be dangerous and I have the onset of diabetes.
Vincent Cournoyer
Respect “youth culture”.
The foundation of treatment for severe obesity “is treatment by a multidisciplinary team in a manner that is guilt-free, inclusive and respectful of young people’s values and culture,” explains Dr. Julie St-Pierre, pediatrician and lipidologist at Maison de health Prevention Approach 180. But in extreme cases, when quality of life, physical health and well-being are compromised, bariatric surgery is considered, she says.
In Quebec, bariatric surgery can be recommended for ages 13 and up, says Dr. St Pierre. In fact, most interventions take place between the ages of 15 and 17.
Performing this surgery at a young age can help preserve the patient’s quality of life and avoid complications in subsequent years, says the specialist.
PHOTO MARTIN TREMBLAY, PRESS ARCHIVE
dr Julie St-Pierre, pediatrician and lipidologist at Maison de santé Prévention-Approche 180
It can prevent a heart attack at 25, a stroke at 35, or a liver or kidney transplant.
dr Julie St-Pierre, pediatrician and lipidologist at Maison de santé Prévention-Approche 180
In addition, more than three-quarters of obesity-related diseases, including liver inflammation, high blood pressure and type 2 diabetes, resolve after surgery, says Dr. Julius Erdstein, a specialist in adolescent medicine at Montreal Children’s Hospital. “It’s not just the number on the scale, it’s life changing,” he says.
The suggestion that a child choose bariatric surgery is “non-trivial,” argues Dr. St Pierre. Some patients experience psychological difficulties after the procedure. “Even after 20 years in this field, I rarely feel comfortable and will be very careful in selecting the patients I refer. »
To ensure he fully understood the implications of the surgery, Vincent met with four doctors with whom he spent several hours. “They explained to me what the operation is, what happens afterwards, what medication I will take and what training and diet I have to do,” he lists.
The child’s choice?
However, experts are concerned about the reasons young people decide to have the surgery. “You have to know if it’s really the kid that’s making the decision [l’opération bariatrique] or when the parents decide to have the child,” says Edith Bernier, founder of the website grossophobia.ca and author of the book Grandir sans grossophobia, which was published at the end of February.
“For consent to be free and informed, it must come from the patient themselves. There may be teenagers who are more shy and don’t want to upset their parents,” says Julien Brisson, specialist in care assessment at CIUSSS du Centre-Ouest-de-l’Île-de-Montréal. .
Teenage brains also make them much more sensitive to their peers and adult image, adds Mr. Brisson. “In the current context, with all the grossophobia, how can we make sure there is no pressure from society to make sure that this intervention is done? “, he asks himself.
A question that particularly appeals to Mrs. Bernier. “I don’t know many people who would have an operation without even thinking about it conforming to societal standards,” she says.
“It’s not a miracle solution”
In the months following the surgery, Vincent is put on a strict diet. “I’ll only be able to take supplements and a few sips of water a few times a day at first,” he says. In the course of the weeks he will be able to “take a few bites”.
Bariatric surgery requires significant mental and physical preparation. For Vincent, who will undergo surgery in the coming months, this is just the beginning of a long and dangerous recovery.
Vincent’s surgery was scheduled to take place at Montreal General Hospital next summer as Montreal Children’s Hospital does not have the resources to perform the procedure.
His best friend, with whom he will soon be moving in for his studies, also met the medical team. “She will be there to take care of me, encourage me and accompany me to my appointments. It will be my moral support,” he said happily.
To ensure the positive effects of the procedure continue, Vincent will be offered post-procedure support and long-term mental health follow-up by a team from Montreal General Hospital.
Edith Bernier is worried about the lack of support after the operation given the current overload of the health network.
PHOTO ANDRÉ PICHETTE, LA PRESSE ARCHIVE
Edith Bernier, founder of the website grossophobia.ca and author of the book Grandir sans grossophobia
Dealing with an operation is a very heavy burden for the family and the child. The operation is not without consequences. It can cause lifelong side effects.
Edith Bernier, founder of the website grossophobia.ca and author of the book Grandir sans grossophobia
The young man’s mother hopes that he will be well cared for after the operation. “He must not think that after everything is settled, he will suffer this and that. No, there are consequences,” says Mélanie Harnois, who has undergone bariatric surgery herself.
After three pregnancies, the mother of a child gained over 100 pounds. At 27, she decided to have bariatric surgery and then lost 150 pounds in one year. Though happy with the result, she felt alone with her new body.
She somehow tries to make her son understand that “this is not a miracle solution”.
It’s a shock to be fat, but it’s also a shock after surgery. You no longer necessarily accept yourself as thin.
Mélanie Harnois, Vincent’s mother, who underwent bariatric surgery herself
Vincent is aware of this. “Because of social media, how other people see the physical is so important. I know that even if I lose weight, my body won’t be perfect and my skin will sag,” he says. But that doesn’t worry him.
“I’m doing the surgery for my health,” he said. All that skin will be the product of my efforts to lose weight. The outside world may not find it pretty, but for me it will be a sign of success. »
Two thirds less stomach
The majority of adolescents who undergo bariatric surgery perform a longitudinal gastrectomy, or gastrectomy. In this procedure, about two-thirds of the stomach is removed, which is reduced to a narrow tube of about 150-200 ml. To be eligible for surgery, the teen must have a body mass index of at least 40 or an index of at least 35 with serious health conditions such as diabetes, cholesterol, blood pressure, or sleep apnea.
Medicines that would prevent the operation are inaccessible
The specialists interviewed by La Presse complain about a lack of funding for the care of young people suffering from obesity. “The great misfortune in Quebec right now is that we are not able to have state-funded continuity of care to avoid drastic solutions like bariatric surgery,” laments Dr. Julie St Pierre. Currently, certain drugs that lead to weight loss could allow young people to avoid the procedure. However, they are not offered in Quebec or are excluded from the Régie de l’assurance maladie du Québec (RAMQ) program. “It’s frustrating,” laments Dr. St-Pierre imploring the government to do more.
Learn more
22 Number of bariatric surgeries performed on minors in Quebec since 2015
Source: RAMQ
21,573 Number of bariatric surgeries performed on 18-64 year olds in Quebec since 2015
Source: RAMQ
809 Number of bariatric surgeries performed on people aged 65 and older in Quebec since 2015
Source: RAMQ