It is common knowledge that we’re facing an obesity epidemic in the United States and other developed nations. During the past 4 decades, the incidence of obesity in adults has doubled, with more than 60% of adult Americans currently overweight or obese. Unfortunately, there has been a corresponding increase in overweight and obesity among adolescents. Weight-related diseases, previously almost unheard of in adolescents as little as 10 years ago, are becoming increasingly commonplace.
These diseases include metabolic syndrome, hypertension, sleep apnea, and diabetes. In fact, the rate of diabetes in obese adolescents has increased 33% in the last decade.
Commonsense tells us that this is a serious problem facing the youngest generation, and doctors and scientists are looking for ways to help. While the necessary outcome is obvious – our teens and children need to lose weight – anyone who has struggled with a weight problem knows how difficult it can be to find a safe and effective way to lose excess weight. The problem is complicated even more for adolescents, who are still growing, who tend to not comply with treatment guidelines, and who have many life experiences ahead of them. Drs. Evan P. Nadler, of Children’s National Medical Center, and George A. Fielding, of New York University School of Medicine, have conducted several trials examining the use of laparoscopic adjustable gastric banding in pediatric patients, and have reported encouraging results.
Laparoscopic Adjustable Gastric Banding (LAGB)
Diet and behavior modification alone help only a small number of adolescents, and most will continue to struggle with obesity into adulthood. Surgical procedures for morbid obesity are becoming more commonplace, and are one of the most effective weight loss tools available. While gastric bypass surgery is the procedure most often performed in the United States, there is some evidence that laparoscopic adjustable gastric banding (LAGB) may be the better option for pediatric patients. LAGB works by placing an inflatable tube around the stomach. This “band” can then be adjusted by adding or removing a saline solution through a subcutaneous port.
LAGB In Children And Teens: Scientific Findings
- An FDA-approved trial found that adolescents had 45 percent weight loss 2 years after surgery, including a decrease in android fat, which plays a role in the development of obesity-related illnesses such as diabetes, heart disease, and insulin resistance. Another study found that weight loss was maintained even after 5 years, with 83% of the adolescents no longer obese.
- LAGB has been shown to improve or resolve comorbid conditions, such as sleep apnea, diabetes, and impaired glucose metabolism. According to Dr. Nadler, "While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications."
- LAGB requires frequent office visits and band adjustments, which raises some concerns in light of well-known noncompliance issues with young people and medical treatment. However, a 2005 study by Dr. Fielding and colleagues found that children were as likely to comply with follow-up visits as their adult counterparts. It is thought that the well-adjusted band’s ability to control hunger provides young patients with an immediate and dramatic improvement in their obesity, and motivates them to follow treatment guidelines. The researchers also noted that every patient decided on their own to undergo the procedure – this personal investment in the decision may also play a role in the high rate of follow-up compliance.
- Nutrition is extremely important for still-growing children and young women who are of childbearing age. Fortunately, minimal negative nutritional effects are associated with LAGB. The folate deficiency that can occur after gastric bypass surgery (which can lead to neural-tube defects in unborn children) has not been reported with LAGB, and it appears that young women are able to safely conceive and deliver babies after undergoing the LAGB procedure. In addition, Dr. Nadler and his colleagues from New York University found that the surgery did not impact bone mineral density, an important consideration for children whose bones are still growing.
- The New York University School of Medicine has demonstrated that LAGB in adolescents can result in equivalent weight loss and significantly less morbidity when compared to gastric bypass surgery. In a 2007 report, doctors at the University concluded that LAGB “remains, in our opinion, the optimal surgical option for pediatric patients with morbid obesity.”
While weight loss surgery is a serious procedure and is not the best course of action for everyone, there is growing evidence that LAGB is a safe and effective treatment for morbid obesity in children and teens. For young people who have been unable to lose weight through other methods and who are suffering from serious comorbid health conditions, LAGB may present a potential solution.