pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Gastric Band for Obese Teens When All-Else Fails

Since mom isn’t daily reminding me to “think of all the starving children in Biafra” I must confess that, perhaps like all of you, I don’t regularly consider that there are millions of other people going about living their daily lives in thousands of other countries – most of whom are also not thinking of me.
Obesity, an icon of the “millennial” generation
On top of that, we sometimes forget that all of those “others” pretty much have the same life issues as we do – including health and medical.

I ran across a recent article about how other physicians around the world are trying to help their patients deal with obesity, a malady which has seemed to attack the U.S. populace as if by some nefarious design.

Obesity, An Icon of “Millennial” Kids

As children have been computerized, indulged and “helicoptered” thousands have become so obese they’ve become diabetic. Long before that, of course, they’re developing insulin resistance, metabolic syndrome and other issues like cardiovascular, testosterone and menstrual disorders.

The 2014 European Congress on Obesity was held in Sofia, Bulgaria and physicians from around the world listened as researchers informed of the results of latest attempts at lessening the burden on these kids.

Obesity and Gastric Banding Surgery

Physicians from France reported results of the longest follow-up study to date (3 years) for gastric “banding” in children and teens. Morbidly obese children (body mass index >40) could only enter the study after all other approaches had failed, including at least 1 to 2 years of on-site multidisciplinary programs such as group-based and behavioral/lifestyle interventions.

Children in the study underwent laparoscopic adjustable gastric-band surgery, a procedure which is loosing favor as an intervention in adults due to its ability to “slip” and need correction. In children, however, it makes sense because it’s the only approach which is reversible.

The results? There usually was immediate weight loss as, within the first month, patients improved their eating habits. Most of the weight was lost in the first two years and nearly all had improved cardiovascular and glucose metabolism status.

Gastric Banding Issues

Obesity surgery only as last resort for teensObesity surgery only as last resort for teens

However, all the issues, benefits and risks have not been completely resolved yet. First, children are still growing and there is the need to prevent nutritional deficiencies.

Second, in addition to being adjustable it’s also reversible. Other bariatric procedures are not. Of great importance in children who are not making decisions on their own.

Third, even though the doctors of the study have been doing the banding procedure since 2008, the study with full follow up has only been underway since 2010 and includes 37 teens (26% male) with a mean age of 16 (range, 14 to 18 years) who weighed 130 kg (286 pounds) on average, and had a mean BMI of 45.

Prior to surgery, 60% of the patients had insulin resistance and 75% of them had metabolic syndrome, but no one had developed type 2 diabetes. Almost half of all the females had menstrual disorders; boys had testosterone abnormalities.

Three years after surgery, median weight loss was 42 kg, corresponding to 69% excess weight loss. There was amelioration of metabolic syndrome and an improvement in cardiovascular-risk profiles.

Fourth, there is the necessity for fairly extensive followup in order to achieve the best results (weight loss) with the surgery. There was a significant correlation with the number of follow-up visits and the amount of weight lost. The average number of visits the patients had was 12 during the first year and 9 in the second.

Therefore, it seems that the surgery is only an “assist” and not a complete “cure” which means that even as a last resort, it may not be the answer for all teen obesity.

Fifth, the surgery is not always beneficial. Five of the 37 (14%) had complications such as regurgitation, heartburn, difficulty swallowing and reflux. According to the researchers, they were not able to determine why this was and there were no obvious predictors of failure.

and Sixth, the procedure is being done in the setting of a health-compromised individual and is not without risk. The research team also reported that there was one death following the banding surgery for which they stopped the study for 6 months during their investigation. The patient died from an abdominal hemorrhage that they were unable to explain but opined that the surgery was not shown to be a contributing factor.

Additionally, I guess a Seventh point, there is the argument over which specialty (pediatric or bariatric) of surgeons should perform the surgery. In the case of the research presented, they were all done by a team of pediatric surgeons.

The chairman of the conference, a bariatric surgeon, didn’t miss the opportunity to express his opinion that bariatric surgeons were the ones who should be doing the surgery – although he did agree that “this operation should be done with a pediatrician team for follow-up but with a bariatric team for surgery.”

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It’s unfortunate that obesity seems to be an icon of the “millennial” generation and gives no comfort to me at all that other countries and cultures are experiencing the life-deforming malady too.

 

[2014 European Congress on Obesity. Abstract T5:S1.1, presented May 29, 2014]

 

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