Teen and Childhood Obesity

At this time there is no clear answer to this question; this applies for adolescents and adults. A significant Australian experience with adjustable gastric banding in adults has provided some good information in regards to the impact of substantial weight loss on adult obesity and comorbidities. To date, Australia has also provided the largest study of adolescent weight loss surgery patients as well. This study consisted of 41 adolescents ranging in age from 12-19 years. The average weight of patients was 125 kg while the average BMI was 42 kg/m2. Of the 41 total patients, three years of data was available on 18 of them; of the 18 patients with three years of data available, weight loss was about 30% three years after weight loss surgery. All adolescent patients with comorbidities experienced improvement, but there is not enough information to conclude what the impact or durability of these improvements may be. Complications included gastric prolapse (band slippage) requiring band repositioning and mechanical problems with the device also requiring re-operation. In the United States, although there is insufficient experience with gastric banding in adolescents to make conclusions regarding it's effectiveness, the band holds significant promise as a low risk option for teens with weight problems. 

The gastric bypass is the standard against which all weight loss procedures must be judged. In adolescents, gastric bypass has been assessed for over a decade. Adolescents experience weight loss of approximately 33% after gastric bypass and preserve an acceptable amount of lean body mass (see figure below); this has been observed in small groups. The resolution of Type 2 diabetes and sleep apnea has been seen in adolescents after gastric bypass; significant metabolic improvements have also been seen. With this said, their are risks of developing intestinal leakage and delayed nutritional deficiencies, especially with B vitamins. 

Prospective studies being conducted at multiple bariatric surgical centers are currently underway (www.cincinnatichildrens.org/teen-LABS) that will be helpful for understanding the positives and negative of gastric bypass surgery for morbidly obese adolescents. Gastric banding is certainly less invasive than gastric bypass. However, maximal weight loss with the band appears to take several years longer than with the bypass. For teenagers who have 60 or 70 more years to live, there is also the concern about revisional surgery for possible device malfunction and mechanical complications. Gastric bypass has been shown to dramatically improve comorbidities and cause durable weight loss but the short-term risks and costs are higher than gastric banding and must be considered when choosing a weight loss surgery option.

Figure: Body Composition

Body composition changes in adolescents undergoing bariatric surgery, adapted from Inge et.al. Control data adapted from Misra et.al. Thomas H. Inge, Kimberly Wilson, Kim Gamm, Shelley Kirk, Victor F. Garcia, Stephen R. Daniels, Preferential Loss of Central (Trunk) Adiposity in Adolescents after Laparoscopic Gastric Bypass. Surgery for Obesity and Related Metabolic Diseases 2007 Mar-Apr;3(2):153-8.

Summary
Morbid obesity threatens the health and lives of our youth. Medical and behavioral interventions for extreme pediatric obesity rarely result in the significant, durable weight loss necessary to improve health outcomes. Weight loss surgery is a tool and must used within the context of a multi-disciplinary bariatric program where healthy behaviors are reinforced. Unlike medical and behavioral interventions, weight loss surgery can result in prolonged weight management, it can enhance an adolescents psychosocial status and improve the comorbidities that threaten life. Therefore, performing bariatric surgery during an individual's adolescence may be more effective than waiting to perform weight loss surgery during adulthood for extremely obese adolescents. Further research must be conducted in this unique population so that we may continue to develop and enhance patient care.

Next >> Teen Weight Loss Surgery - A Case Study from Cincinnati Children's Hospital

This information has been provided by Dr. Thomas Inge, Surgical Director of the Surgical Weight Loss Program for Teens at Cincinnati Children?s Hospital Medical Center, a national leader in the pediatric weight loss surgery field. Dr. Inge also serves as the chairman of Teen-LABS, the largest scientific study to date designed to learn more about the risks and benefits of surgery for teenage obesity. Click here to learn more about this study.