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Gastric Band Surgery Rising Among Obese Teens

More research needed on long-term safety, effectiveness, researchers say

MONDAY, Sept. 20, 2010 (HealthDay News) -- More overweight teenagers are undergoing laparoscopic gastric band surgery, a weight-loss procedure that isn't approved for anyone under 18 years old, a new study finds.

Looking at a database of bariatric surgeries in California, researchers found that gastric band operations, which constrict the stomach, increased seven-fold from 2005 to 2007.

The rates are going up "as diet and activity are proven again and again to be ineffective at getting morbidly obese patients to lose weight," said study co-author Dr. Daniel A. DeUgart, a pediatric surgeon at the University of California, Los Angeles.

Weight-loss surgery has surged in popularity over the past decade. Gastric bypass surgery, the gold standard, routes food away from much of the stomach, but the study found that fewer teens were opting for that procedure, and signing up for gastric banding instead.

Both operations are designed to make it difficult for people to overeat because they'll feel sick if they do.

For the study, published online Sept. 20 in the journal Pediatrics, the researchers found that 590 people between 13 and 20 years old underwent gastric band or gastric bypass surgery in the period studied.

Eighteen percent of the patients were under 18, and almost 80 percent were female.

And while whites make up only 28 percent of overweight adolescents in California, they accounted for 65 percent of the weight-reduction operations.

Some experts, including DeUgart, believe the surgeries are needed; others express concern that teens may be risking their health looking for a quick fix.

Most of the weight-reduction surgeries (93 percent) were performed in hospitals that are not affiliated with nationally recognized children's hospitals, the study authors reported.

The authors also noted that although "manufacturers have touted the banding procedure as less invasive, many [medical] centers have abandoned gastric banding because of poor long-term results," concerns about chronic esophageal blockage, the need for frequent readjustments, and complications from the surgery.

As with any operation, weight-loss surgery can cause serious complications, including infection, leaks, respiratory arrest, blood clots and death, according to the American Society for Metabolic & Bariatric Surgery. (No deaths were reported in this study.)

Then there's cost: about $17,000 and up for the average gastric band procedure, according to experts. Most of the families of patients in the current study paid that amount out-of-pocket.

Dr. Edward Livingston, a gastric surgeon at the University of Texas Southwestern School of Medicine, is concerned about the popularity of weight-loss surgeries and the surgeons themselves.

"These operations clearly help some people, but they're trying to sell it as a solution for everybody," he said. "If you follow the rules it works. But most people who get to be 400 pounds aren't very good at following rules."

Proponents argue that obesity carries its own health risks.

Morbid obesity is a major problem for today's youth, DeUgart said, noting some over-sized students must be home-schooled because they don't fit into the chairs in their local public schools.

"Bariatric surgery is increasingly becoming a treatment option for adolescents, and in the right setting and with proper evaluation, it may be appropriate," said DeUgart.

Research suggests that for severely obese patients, weight-loss surgery may be the most effective method of weight loss, according to background information in the study.

But bariatric surgery isn't a cure-all for obesity. The study doesn't say if the procedures kept weight off in the long term.

The authors note that further studies are needed to assess the long-term safety and effectiveness of the operations in this age group. In addition, some insurance companies won't cover the operations.

Many teens aren't emotionally ready for a huge change in how they look at food, Livingston added. "When you force that kind of change on them, you can run into trouble," he said.

More information

For more about weight-loss surgeries, visit the U.S. National Library of Medicine.

SOURCES: Daniel A. DeUgarte, M.D., pediatric surgeon, University of California at Los Angeles; Edward H. Livingston, M.D., professor and chairman, gastrointestinal and endocrine Surgery, Dallas; October 2010 Pediatrics, online Sept. 20
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