“I can’t wait, but I know it won’t be the easy solution. At the end of the line, the young Vincent Cournoyer, 18, is feverish. Suffering from severe obesity since the beginning of adolescence, he will undergo in the coming months a bariatric operation which aims to make him lose weight to improve his state of health.
At the age of 12, Vincent developed an eating disorder, which 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 felt 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 in an attempt to lose the calories he had just ingested. “I was addicted to the game Just Dance, because I danced all the time after my seizures, for two or three hours,” he says. He also hid food, “just in case [il avait] a need to eat,” he says.
Quebec offers adolescents a path to bariatric intervention, which is considered an effective intervention for some patients. The majority of teenagers who undergo bariatric surgery have a sleeve gastrectomy. This procedure involves removing about two-thirds of the stomach, 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 lbs.
It was hard to see my body change. I saw all the stretch marks on my body. I was bullied about my weight throughout my childhood.
Vincent Cournoyer
Despite follow-ups with a psychologist to treat her eating disorder, the number on the scale kept rising. Her mother contacted the Center of Excellence for Severe Obesity in Adolescents at the 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, bringing together a doctor, nutritionist, psychologist, social worker and kinesiologist. His eating disorder slowly resolved. “I’m 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 lbs. Given his state of health, 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 basis of treatment for severe obesity “is management by a multidisciplinary team in a way that relieves guilt, is inclusive and respects the values and culture of young people”, explains Dr. Julie St-Pierre, pediatrician and lipidologist at the Maison de health Prevention-Approach 180. But in extreme cases, where there are impairments to quality of life, physical health and well-being, bariatric surgery is considered, she says.
In Quebec, the bariatric operation can be recommended from the age of 13, indicates the Dre St Pierre. In fact, the majority of interventions take place between the ages of 15 and 17.
Performing this operation at a young age can help maintain the patient’s quality of life and avoid complications in the years that follow, says the specialist.
PHOTO MARTIN TREMBLAY, ARCHIVES LA PRESSE
The Dre Julie St-Pierre, pediatrician and lipidologist at the Maison de santé Prévention-Approche 180
It can prevent having a heart attack at 25, having a stroke at 35 or a liver or kidney transplant.
The Dre Julie St-Pierre, pediatrician and lipidologist at the Maison de santé Prévention-Approche 180
In addition, more than three-quarters of obesity-related health conditions, including liver inflammation, high blood pressure and type 2 diabetes, resolve following surgery, says Dr. Julius Erdstein, specialist in adolescent medicine at the Montreal Children’s Hospital. “It’s not just the number on the scale, it’s life changing,” he says.
Suggesting that a child opt for bariatric surgery is “not trivial,” argues Dr. St-Pierre. Some patients will experience psychological difficulties following the procedure. “Even after 20 years in the field, I rarely feel comfortable and I will be very careful in choosing the patients I refer. »
To make sure he fully understood the implications surrounding the operation, Vincent met four doctors with whom he spent several hours. “They explained to me what the operation is, what will happen afterwards, what types of medication I will be taking and the training and the diet that I will have to do”, he lists.
The choice of the child?
Experts are concerned, however, about the reasons that lead young people to opt for the operation. “You have to know if it is really the child who chooses to do [l’opération bariatrique] or if the parent chooses for the child,” says Edith Bernier, founder of the grossophobia.ca website and author of the book Grandir sans grossophobia, published at the end of February.
“For it to be free and informed consent, it has to come from the patient himself. There may be teenagers who are more shy and who don’t want to upset their parents,” says Julien Brisson, care assessment specialist at the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal. .
Teenagers’ brains also make them much more sensitive to their peers and their image than adults, adds Mr. Brisson. “In the current context, with all the grossophobia, how do we ensure that it is not pressure from society to want to make sure that this intervention is carried out? “, he wonders.
A question that particularly appeals to Ms. Bernier. “I don’t know many people who would go in for an operation without having at least a slight thought that they’re going to be more up to societal standards afterwards,” she says.
“It’s not the miracle solution”
In the months following the operation, Vincent will be put on a strict diet. “Initially, I will only be able to take food supplements and sips of water a few times during the day,” he says. Over the weeks, he will be able to “start taking a few bites”.
Bariatric surgery requires significant mental and physical preparation. For Vincent, who will have surgery in the coming months, this is only the beginning of a long and perilous recovery.
Vincent’s operation should take place next summer at the Montreal General Hospital, since the Montreal Children’s Hospital does not have the resources to perform the procedure.
His best friend, with whom he will soon move in for his studies, also met the medical team. “She will be there to watch over me, to encourage me and to accompany me to my appointments. It’s going to be my moral support,” he said happily.
To ensure that the positive effects of the intervention last, support and long-term mental health follow-up will be offered to Vincent after the intervention by a team from the Montreal General Hospital.
Edith Bernier is worried about the lack of support after the operation, given the current overload in the health network.
PHOTO ANDRÉ PICHETTE, LA PRESSE ARCHIVES
Edith Bernier, founder of the grossophobia.ca website and author of the book Growing up without fatphobia
Dealing with surgery is a very heavy burden to put on the family and the child. The operation is not without consequence. It can create lifelong side effects.
Edith Bernier, founder of the grossophobia.ca website and author of the book Growing up without fatphobia
The young man’s mother hopes that he will be well cared for following the operation. “He mustn’t think he’s going to suffer this and that after everything will be settled. No, there are sequelae,” says Mélanie Harnois, who herself underwent bariatric surgery.
After three pregnancies, the mother-of-one gained over 100 lbs. At 27, she opted for bariatric surgery and then lost 150 lbs in a year. Although satisfied with the result, she felt alone with her new body.
She tries, somehow, to make her son understand that “this is not the miracle solution”.
It’s a shock to be fat, but it’s also a shock after the operation. You don’t necessarily accept yourself as thin anymore.
Mélanie Harnois, Vincent’s mother, who herself underwent bariatric surgery
Vincent is aware of this. “Because of social networks, the way others look at the physical is so important. I know that even if I lose weight, my body will not be perfect and I will have skin that will hang down,” he says. But that doesn’t worry him.
“I’m doing the operation for my health,” he said. All that skin will be the product of the effort I put into losing weight. The outside world may not find it beautiful, but for me it will be a sign of success. »
Two-thirds less stomach
The majority of adolescents undergoing bariatric surgery have a sleeve gastrectomy, or sleeve gastrectomy. This procedure involves removing about two-thirds of the stomach, which is reduced to a narrow tube of about 150-200 ml. To have access to the operation, the teenager must have a body mass index of at least 40 or an index of at least 35 with severe health conditions, such as diabetes, cholesterol, blood pressure or sleep apnea.
Medications that would prevent the operation inaccessible
The specialists met by The Press denounce a lack of financing in the care of young people suffering from obesity. “The great misfortune at present in Quebec is that we are not able to have a continuum of care funded by the state to avoid having to come up with drastic solutions such as bariatric surgery”, laments the Dre Julie St-Pierre. At the present time, certain medications, leading to weight loss, could allow young people to avoid the intervention. 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 the Dre St-Pierre, who implores the government to do more.
Learn more
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- 22
- Number of bariatric operations performed on minors in Quebec since 2015
Source: RAMQ
- 21 573
- Number of bariatric operations performed among 18 to 64 year olds in Quebec since 2015
Source: RAMQ
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- 809
- Number of bariatric operations performed among people aged 65 and over in Quebec since 2015
Source: RAMQ