Bariatric Surgery in Adolescents: Current data on the decision and the options (#22)
We have an escalating problem. The 2007-08 Australian National Health Survey showed that the rate of obesity for children aged 5-17 years increased from 5.2% in 1995 to 7.5% in 2007-08. In the USA, during the period 1980 – 2010 the percentage of adolescents, aged 12–19 years, who were obese increased from 5% to 18%.
The obese adolescent suffers a range of broad range of serious medical, physical and psychosocial consequences including type 2 diabetes, sleep apnoea, depression, social isolation, low self-esteem and the likely prospect of obesity as an adult. Prevention would be ideal but is not yet achieved as the problem continues to grow. We must seek to assist those who are already obese.
We randomised 50 obese adolescents (BMI > 35 and aged 14 -18) who had tried and failed repeated attempts at weight loss to a 2 yr intensive multidisciplinary weight loss program based on lifestyle change or laparoscopic adjustable gastric banding (JAMA 2010; 303:519-26). At 2 yr, the lifestyle group had lost a small amount of weight (3 kg; 13 % of their excess weight). The gastric banding group lost substantial weight (35 kg; 79% of their excess weight) and reduction of the metabolic syndrome from 36% to zero. There were no perioperative adverse events but significant need for revisional procedures during the two years. Importantly, two of the lifestyle group achieved substantial and durable weight loss.
Our results concur with a recent Cochrane meta-analysis of RCTs that report the lifestyle treatment options are generally not sufficient. But they must be the first approach. The period of treatment should be defined and, if unsuccessful, consideration should then be given to a surgical option. The safety, effectiveness, reversibility and adjustability of gastric banding makes it preferred over gastric stapling procedures, such as sleeve gastrectomy or gastric bypass.