Laparoscopic Gastric Banding: An Option for Very Obese Teens?

Reprinted from Eating Disorders Review
March/April 2010 Volume 21, Number 2
©2010 Gürze Books

Adolescent obesity now affects more than 5 million teens in the U.S. One method that is being considered for treating severely obese teens is bariatric surgery. Laparoscopic adjustable banding (gastric banding) might provide a safe and effective treatment for this group of patients, according to a group of Australian physicians. The physicians decided to test the efficacy of laparoscopic gastric banding versus lifestyle modification in a controlled trial of 50 severely obese teens (JAMA. 2010; 303:519).

The teens were between 14 and 18 years of age, and had body mass indexes higher than 35 kg/m2 Between May 2005 and September 2008, the teens were assigned either to a supervised lifestyle intervention program (25 teens) or scheduled to undergo gastric banding (25 teens), and all were followed for two years. Secondary outcomes included changes in metabolic syndrome status and insulin resistance, quality of life, and adverse outcomes.

Gastric banding: greater weight and BMI reductions

As Dr. P.E. O’Brien and colleagues at Monash University Medical School, Melbourne, Australia, reported, 24 of 25 patients in the gastric banding group and 18 of 25 in the lifestyle modification group completed the study. Twenty-one in the gastric banding group (84%) and 3 (12%) in the lifestyle modification group lost more than 50% of their excess weight, corrected for age. Among the gastric banding group, the mean weight loss was 34.5 kg, representing an excess weight loss of 78.8% of excess weight, and a loss of 12.7 BMI units, and a BMI z score change from 2.39 to 1.32. In comparison, the mean weight loss among the lifestyle change group was 3.0 kg, representing loss of 13.3% of excess weight, a loss of 1.3 BMI units, and a BMI z score change from 2.41 to 2.26.

At baseline, 9 participants in the gastric banding group (36%) and 10 in the lifestyle change group (40%) had the metabolic syndrome. After 24 months, none of the teens in the gastric banding group had the metabolic syndrome (P=.008), compared with 4 of the 18 teens who completed the lifestyle intervention program (22%) (P=0.13).

As for quality of life, the gastric banding group reported improved quality of life, and had no adverse effects during surgery. However, 8 operations were required in 7 of these patients for revisional procedures, either for proximal pouch dilation or to repair tubing injuries that occurred during follow-up.

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