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Selections from Journal Watch Pediatrics and Adolescent MedicineCopyright © 2006 Massachusetts Medical Society. All rights reserved.
Adult gastric banding: implications for adolescents ▸
In obese post-pubertal adolescents, gastric banding should be considered.
Only observational studies of gastric banding in adolescents have been reported, but data from randomized trials in adults are likely to be helpful for advising parents and obese adolescents about treatment options. In an industry-supported study, Australian investigators randomized 80 adults (age range, 20–50 years; body-mass index, 30–35 kg/m2) either to laparoscopic adjustable gastric banding or to treatment that involved behavior modification, very-low-calorie diets, and orlistat (Xenical) therapy.
Two years after enrollment, virtually all outcomes favored the surgery group. For example, weight loss was significantly greater in the surgery group than in the nonsurgery group (mean weight at 2 years, 74.5 kg vs. 89.5 kg). The metabolic syndrome had resolved in 14 of 15 patients in the surgery group versus 7 of 15 in the nonsurgery group. Quality of life improved in all eight domains in the surgery group compared with only three of eight domains in the nonsurgery group. Adverse events occurred in 5 patients in the surgery group (1 patient had an infected port site, and 4 had prolapse of the gastric wall that required repeat surgery) and in 12 patients in the nonsurgery group (1 patient could not tolerate the diet, and 11 could not tolerate orlistat).
Although dozens of weight-loss programs have been developed for children and adolescents, maintaining substantial weight loss has been difficult. Despite risks associated with surgery, I believe that, in morbidly obese postpubertal adolescents, we should consider surgery. As we have reported previously, surgery candidates should undergo comprehensive medical and psychological evaluations to assess their suitability for this procedure (JWPAM Oct 12 …