Study finds gastric-bypass successes for teens

LOS ANGELES — Gastric-banding surgery appears to be significantly more effective than lifestyle interventions in helping severely obese teenagers lose a significant amount of weight and keep it off, a new study suggests.

In the U.S., the banding procedure is currently available to adolescents only through research studies. It involves placing an adjustable device on the upper part of the stomach and creating a pouch that allows only small amounts of food, creating feelings of fullness sooner.

With the health benefits of gastric-bypass surgery becoming more obvious, however, some doctors hope the band will be approved by the Food and Drug Administration for adolescents. Other forms of gastric-bypass surgery can be used in teenagers, but the banding device is considered less invasive and less permanent.

The new, randomized study, reported online Tuesday in the Journal of the American Medical Association, included 50 Australian teens age 14 to 18 with a body mass index of more than 35 (considered severely obese). Half received the surgery; the other half took part in a lifestyle intervention that included individualized diet plans, exercise sessions with a personal trainer, and follow-ups with health care providers. Both groups were tracked for two years.

All the teens lost weight, but those who had surgery came out ahead. They lost about 79 percent of their excess weight, compared to about 13 percent in the lifestyle group.

Further, nine teens in the surgery group and 10 in the lifestyle group started the study with metabolic syndrome, a group of health risk factors that includes excess abdominal fat, high blood pressure and insulin resistance. Over time, the syndrome can lead to heart disease and diabetes. After two years, no one in the surgery group had the syndrome; four in the lifestyle group did.

Seven patients in the gastric-banding group required revisions to their surgery.

The lifestyle group, despite not losing as much weight as the surgery group, did show some improvements. "We did reasonably well with the lifestyle group," said Dr. Paul O'Brien, lead author of the study and director of the Centre for Obesity Research and Education at Monash University in Melbourne. "But that's the nature of lifestyle methods. ... Everyone can lose weight dieting, and some can lose an awful lot of weight, but almost nobody can keep it off after many years."

O'Brien added that he was disappointed with the number of revisions in the surgical group, but that it emphasizes the need to educate patients about how to eat properly with the band. The gastric bands used in the study were provided by Allergan, which also gives grant money to O'Brien's center.

Another study in the Journal of Pediatric Surgery in 2007 showed similar results among 53 teens age 13 to 17 who underwent gastric-banding surgery. After six months the average excess weight loss was about 38 percent, at one year it was about 63 percent, and at 18 months, about 49 percent. In that study, however, there was no lifestyle intervention or control group.

Still, the progress made by the lifestyle group in the current study should not be discounted, said Dr. Michael Goran, director of the University of Southern California Childhood Obesity Research Center. "In diabetes prevention, we talk about a 7 percent excess weight loss as being significant," he said. "So for the teens in the study, that's actually pretty good, especially if it was maintained."

He also pointed out that although gastric surgery showed better results, it still is no magic pill. "Surgery has potential side effects, and although the band is reversible, it still doesn't replace lifestyle changes, which is why that's recommended as a first line of attack."

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