Gastric Banding May Allow Significant Weight Loss in Obese Teens

February 9, 2010 - Gastric banding may be more effective than lifestyle intervention in achieving weight loss in obese adolescents, according to the results of a prospective, randomized controlled trial reported in the February 10 issue of the Journal of the American Medical Association (JAMA).

"Adolescent obesity is a common and serious health problem affecting more than 5 million young people in the United States alone," write Paul E. O'Brien, MD, FRACS, and colleagues of Monash University and the Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia, and colleagues. "Bariatric surgery is being evaluated as a possible treatment option. Laparoscopic adjustable gastric banding has the potential to provide a safe and effective treatment."

The goal of this study was to compare the outcomes on adolescent obesity of gastric banding vs an optimal lifestyle program. Between May 2005 and September 2008, a total of 50 adolescents aged 14 to 18 years with body mass index (BMI) of more than 35 were recruited from the community and randomly assigned to a supervised lifestyle intervention or (alternatively) to undergo gastric banding.

In the gastric banding group, 85% lost more than 50% of their excess weight, compared with only 12% in the lifestyle group. In the gastric banding group, mean weight loss was 35 kg representing an excess weight loss of 78.8% (12.7 BMI units). In the lifestyle group, mean weight loss was 3.0 kg, representing an excess weight loss of 13.2% (1.3 BMI units).

Metabolic syndrome was present at entry in 9 participants (36%) in the gastric banding group and in 10 participants (40%) in the lifestyle group, but at 24 months, none of the gastric banding group had the metabolic syndrome vs 22% in the lifestyle group. Participants in the gastric banding group also reported improved quality of life. Although there were no perioperative adverse events, 8 surgical revisions (33%) were required in 7 patients either for proximal pouch dilatation or technical matters related to the prosthesis.

"Among obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage achieving a loss of 50% of excess weight, corrected for age," the study authors write. "There were associated benefits to health and quality of life."

"In this study, gastric banding proved to be an effective intervention leading to a substantial and durable reduction in obesity and to better health," the study authors conclude. "The adolescent and parents must understand the importance of careful adherence to recommended eating behaviors and of seeking early consultation if symptoms of reflux, heartburn, or vomiting occur. As importantly, they should be in a setting in which they can maintain contact with health professionals who understand the process of care."

JAMA. 2010;303:519-526, 559-560.

Write Your Comments: