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 available to adolescents only through research studies. It involves placing an adjustable device on the upper part of the stomach to make a pouch that allows only small amounts of food, creating feelings of fullness sooner.
With more evidence of the health benefits of gastric bypass surgery, some doctors hope the Food and Drug Administration will approve the band 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 Assn., involved 50 Australians between the ages of 14 and 18 with body mass indexes 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 healthcare providers. Both groups were tracked for two years.
All of the teens lost weight, but those who had surgery came out ahead. They lost about 79% of their excess weight, compared with about 13% 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 risk factors that includes excess abdominal fat, high blood pressure and insulin resistance. 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 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 said that it pointed to 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.
A study in the Journal of Pediatric Surgery in 2007 showed similar results among 53 teens ages 13 to 17 who underwent gastric banding surgery. After six months, the average excess weight loss was about 38%; at one year it was about 63%; and at 18 months, about 49%. In that study, however, there was no lifestyle intervention or control group.
Still, the progress made by the lifestyle group in the current study shouldn't be discounted, said Dr. Michael Goran, director of the USC Childhood Obesity Research Center. "In diabetes prevention, we talk about a 7% 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 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."