But experts stress that obese kids do have non-surgical options that may work
By Robert Preidt
FRIDAY, June 15 (HealthDay News) -- Many doctors hesitate to recommend weight-loss surgery for obese teenagers, but a new study has found that may be both safe and effective.
Researchers at the University of Miami Miller School of Medicine analyzed data from more than 400 surgeons at 360 facilities across the United States who performed weight-loss procedures on nearly 900 very obese male and female patients aged 11 to 20.
Two types of procedures, gastric bypass surgery and gastric band surgery, were performed. Gastric bypass surgery divides the stomach into a larger and smaller section and attaches the small intestines to the smaller stomach pouch. In gastric band surgery, a silicone band is placed around the stomach to reduce its size.
After one year, both methods reduced the patients' weight and body-mass index (a measure of body fat based on height and weight). Both surgeries also led to substantial improvements in several obesity-related physical- and mental-health problems, including high blood pressure, diabetes and depression, the researchers said.
The average amount of weight loss among all patients was 66 pounds. Patients who had gastric bypass surgery lost more than twice as much weight as those who had gastric band surgery.
"These positive outcomes after bariatric surgery have not been documented for other treatment options, especially in this age group," study leader Sarah Messiah, a research associate professor and perinatal/pediatric epidemiologist, said in a university news release.
One patient in the study died from cardiac arrest five months after surgery. However, the death rate from bariatric surgery remains much lower than almost any other type of surgery, Messiah said.
She noted that this was the first large-scale study of bariatric surgery in this age group and could change the treatment options offered to very obese youth.
Experts cautioned, however, that weight-loss surgeries do have risks compared to lifestyle changes in diet and physical activity.
"This study provides us with data about some of the benefits of bariatric surgery for morbidly obese adolescents, however there are still several caveats that should be kept in mind," said Dr. Lisa Altshuler, director of Kids-Weight Down at Maimonides Medical Center, in New York City.
"The authors indicate their subjects included patients 11 to 18, although given the mean age of the patients, it seems that most were closer to 18 than 11," she said. "Surgery is a drastic solution, and anything that disrupts absorption of nutrients can have an effect on younger adolescents who are not close to the end of their growth. In choosing between surgery versus intensive behavioral treatment of diet and exercise, one must always weigh the costs/potential risks of surgery against the obesity-related problems an adolescent suffers. And the younger the age of the adolescent, the more concern there should be about such surgery."
Another expert agreed. "Although this article demonstrates that surgery is an option for obese adolescents, it is important to remember that it should not be the first line of treatment for all obese adolescents," said Nancy Copperman, director of Public Health Initiatives in the Office of Community Health at the North Shore-LIJ Health System, in Great Neck, NY.
She said that a "team approach" to lifestyle change -- including a pediatrician, registered dietitian and psychologist -- can help obese children slim down without surgery.
And family support is crucial. "Families that support their child by joining him in lifestyle changes such as exercise and healthy meals, and helping him to problem-solve difficult situations will have the most success," Copperman added.
The study, published online in Surgery for Obesity and Related Disease, will appear in a future print issue of the journal.
The Nemours Foundation has more about teens and weight-loss surgery.
SOURCE: Lisa Altshuler, M.D., director, Kids-Weight Down, Maimonides Medical Center, New York City; Nancy Copperman, M.S., R.D., C.D.N., director, Public Health Initiatives, Office of Community Health, North Shore-LIJ Health System, Great Neck, N.Y.; University of Miami, news release, June 12, 2012
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