Only a few doctors in the country will do the procedure on teens.
BUFFALO GROVE, Ill. (AP) -- Sam Fabrikant is a few minutes older than his brother, Charlie. But he's always been the quieter of the two, the follower -- even when he didn't necessarily want to be.
Take, for instance, the matter of their weight. Charlie started putting on extra pounds in first grade and eventually dropped out of sports because he couldn't keep up. In fifth grade, Sam started to see the effects of his own weight gain. And by their teen years, the fraternal twins were -- in their words -- "morbidly obese."
"It wasn't good," says Charlie, who's 5-foot-10 and weighed 350 pounds about this time last year. Sam, who's 5-foot-7, was hovering around 290.
That's when Charlie decided to do something drastic and controversial: He had gastric bypass surgery, performed by one of only a few doctors in the country who'll do the procedure on teens. Now a high school junior in suburban Chicago, he underwent months of physical and psychological screening before the surgery and has since lost about 130 pounds. He also no longer suffers from ailments related to his obesity, such as sleep apnea, joint pain, severe heartburn and asthma.
The results prompted Sam, who'd been hesitant about the surgery, to follow suit. Last month, just as his winter break began, doctors rerouted several feet of his small intestine and stapled his stomach to reduce its capacity from football size to that of a golf ball.
Now and for the rest of their lives, the twins can eat no more than a half cup of food in one sitting -- that's less than one slice of pizza or maybe a quarter of a hamburger.
"Surgery, for me, was my last option," says Sam, who continued to try and lose weight over the last year through diet and exercise, with minimal results. "The big motivation for me is to lead a healthy life."
Watching his brother go through recovery -- and feel better in the long run -- also helped calm Sam's fears about the procedure, though it ended up being much more difficult for him than Charlie. Among other things, Sam developed a blood clot in a lung and spent several days in intensive care after surgery.
He is, however, expected to return to school later this week.
"Charlie, in my mind, is one of the first pioneers of this. Now I guess I'm another," says Sam, who hopes to lose 100 pounds in the coming months, putting him below the 200-pound mark.
Though doctors agree that obesity is a major health problem, many say that gastric bypass is a procedure teens are both physically and emotionally too young to handle. They also note that, because the surgery is relatively new, the long-term effects are unknown.
Still, Dr. Chris Salvino, the Chicago-area doctor who did the twins' gastric bypasses, believes some teens -- namely, those whose severe obesity causes them to suffer from diabetes, high blood pressure, sleep apnea and other ailments -- are good candidates for the surgery. In the last two years, he and fellow surgeons in his practice have done the procedure on more than two dozen teens, the youngest of whom was 15.
For some young people, Salvino says, "it's not a lack of willpower; it's a genetic problem."
Outweighing the risks
He also believes that the health benefits resulting from the surgery outweigh the risks, which include everything from the chance of infection and stomach leakage to staples coming undone, requiring further surgery.
Wendy Fabrikant, the twins' mother, had her own gastric bypass done in 2001 and says concerns about the effects of obesity topped any fears about the operation for herself and the boys.
"It was reliving everything, having a weight problem myself. The blueprint had been laid," says Fabrikant, who has lost 90 pounds. Before surgery, she had to use a walker or a cane to get around.
As her sons gained weight, she took them to pediatric nutritionists, put them on various diets and tried medicine prescribed by doctors to curb their appetites.
She watched as her athletic young boys -- whose soccer, baseball and basketball trophies still line a wall in the family den -- withdrew from sports and social activities. Increasingly, kids at school teased them.
"They hit you with 'smack talk' -- call you fat or whatever -- and you feel so powerless," Charlie says. "It's someplace you never want to be."
Charlie, in particular, stopped going to Northwestern University football games with his dad because he was too big to fit into his seat.
He also often refused to go to social gatherings or would ask to leave early. And his parents weren't sure he'd even attend his own bar mitzvah, though he did so grudgingly.
Sam understood his brother's hesitance: "If someone says their self-esteem doesn't go down," he says, "they'd be lying."
Though recovery from the surgery can be quite painful in the first few months -- something Sam is experiencing now -- Charlie says having a gastric bypass is "the best thing I've ever done," even if it means having to eat six half-cup meals a day, supplemented with vitamins and regular exercise.
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