Alana 'Honey Boo Boo' Thompson Is Considering Weight Loss Surgery — but Should Teens Get it? A Doctor Explains

Dr. Christopher McGowan explains to PEOPLE what an endoscopic sleeve gastroplasty (ESG) is and whether the procedure is safe for children and teens

Alana "Honey Boo Boo" Thompson from TLC's reality TV series "Here Comes Honey Boo Boo" attends Build Brunch at Build Studio on March 14, 2019 in New York City.
Photo: Slaven Vlasic/Getty

Earlier this week, Alana Thompson revealed she is considering getting a suture sculpt endoscopic sleeve — typically referred to as an endoscopic sleeve gastroplasty (ESG) — after unsuccessfully trying to lose the weight by herself over the past year.

The 16-year-old reality star, also known as Honey Boo Boo, admitted that though she lacks incentive for healthy eating, she believes the weight loss surgery will give her additional motivation to try to get down to about 145 lbs.

PEOPLE spoke with Dr. Christopher McGowan, a gastroenterologist and obesity medicine specialist with True You Weight Loss, to discuss how an ESG works and whether the procedure is best for children to undergo.

What is endoscopic sleeve gastroplasty?

The ESG is a form of weight loss surgery that involves suturing, or sewing, the stomach to reduce its size by up to 70 to 80%. It typically causes significant weight loss by limiting how much a person can eat.

It is a minimally invasive procedure as it's performed by inserting a device into the throat and down to the stomach. ESG can be a good option for individuals who have tried traditional methods for weight loss — diet and exercise — without success.

"We're basically placing stitches in the inside of the stomach to make it about 70 to 80% smaller," McGowan explains to PEOPLE. "So with the reduction in stomach size, that patient then feels full with much smaller portions, the stomach is slower to empty so they retain their meals longer. And ultimately, they're able to lose weight over time. But the major difference here is that it's done through the mouth. So the recovery is vastly easier for the majority of patients, and the risk is significantly lower compared to traditional bariatric surgery."

Alana ‘Honey Boo Boo’ Thompson Considering ESG Weight Loss Surgery — Should Children Get it? A Doctor Explains
Brian Strickland Photography

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The average weight loss after an ESG is around 17 to 20% of total body weight, McGowan says.

"So someone starting at 200 lbs. could expect to lose approximately 40 lbs. with the ESG procedure — assuming that they're engaged in the follow up program, they have nutritional support, and they're involved in a comprehensive weight loss program," he adds. "So that's the average weight loss, which is quite significant. If you compare it to diet and exercise alone, the average weight loss is perhaps 1 to 3% at best."

"But utimately, this is a tool," he says. "We definitely cannot look at a weight loss procedure, ESG or otherwise, as an easy fix. And that was one of the major concerns that I saw on this [Alana Thompson] report was someone who was clearly not ready and actually said, 'I'm not motivated, I have no motivation. I think this will give me the motivation.' And really the motivation has to come from inside and we can't provide that with a surgical procedure."

Should children get an ESG?

The ESG procedure is currently only authorized by the U.S. Food and Drug Administration for the treatment of obesity in adults 18 and older.

"It is not authorized for use in adolescents," McGowan stresses. "Now, can it be performed safely? It can. The procedure is quite safe. And there's at least one large study that showed that it's safe and effective, but there's a much bigger issue here."

Treating weight in children is complex, McGowan says, noting that they are not fully emotionally mature. "So whether they could technically have the procedure is really not the question," he adds. "The question is, is it the right procedure for that person at that time in their life?"

Alana ‘Honey Boo Boo’ Thompson Considering ESG Weight Loss Surgery — Should Children Get it? A Doctor Explains
Brian Strickland Photography

McGowan says the patient needs to be mature and fully engaged in the process to understand the risks and adhere to the recommendations. Following an ESG, the patient will need to make necessary lifestyle changes, specifically with eating habits and regular exercise, in order for the procedure to be effective in long-term weight loss.

He adds that there is a significant follow-up program with the ESG which typically includes having good nutritional support, psychological support, and family support.

"In my own practice, I actually don't recommend the ESG procedure for individuals below the age of 21. Because really, emotional maturity, psychological maturity is probably not reached until well into your 20s," McGowan says. "And so the big concern here is not really the risk of the procedure, it's the risk of the outcome. It's a concern that that individual is not ready to really engage in the process long term and they just won't do well. They won't make the necessary changes."

Alana ‘Honey Boo Boo’ Thompson Considering ESG Weight Loss Surgery — Should Children Get it? A Doctor Explains
Brian Strickland Photography

When should someone consider getting an ESG?

If an individual is considering getting an endoscopic sleeve gastroplasty, doctors will first want to see proof that they have invested real effort into trying weight loss with traditional diet and exercise modification.

"If that hasn't worked, and the adult adolescent is still obese and really needs a more aggressive or effective intervention, then it's really about starting the process early and engaging the entire family," McGowan explains. "Programs that offer successful weight loss procedures to adolescents, start with family focused education, spend time — we're talking about months of time — with the family and with the patient."

Prior to getting the ESG, McGowans says patients need to undergo psychiatric evaluations and have additional support to ensure they're fully ready to start the weight loss journey.

"So it's definitely not an easy path. It's not a process that takes less work, it actually takes more work. And that's something that that patient needs to understand. And they also need to be able to understand the risks."

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