US teens seeking
weight-loss surgery have a startling number of health problems that used to be
seen only in adults, according to a major government-funded study.
Half the teens had at least
four major illnesses linked with their excess weight. Three out of four had
cholesterol problems; almost half had high blood pressure or joint pain; and
many had diseased livers or kidneys.
These kids weighed three
times more than what is considered healthy, they weren't just teens "who
want to fit into that cheerleading outfit better," said Dr Thomas Inge,
the study's lead researcher and a surgeon at Cincinnati Children's Hospital
Is obesity surgery safe?
The study offers reassuring
evidence that obesity surgery is generally safe for teens, echoing previous
short-term research. While it is a drastic, last-ditch option, major
complications including accidental injury to internal organs occurred in just 8%
of teens. Less serious complications including bleeding and dehydration
affected 15% of kids during the first month after surgery.
The study involved 242
teens who had surgery at five US centres from 2007 through 2011. Results for
the first month after surgery were released online Monday in the journal JAMA Paediatrics.
The National Institutes of Health paid for the study.
In a recent scientific
statement, the American Heart Association said obesity surgery may be the most
effective treatment for what it called "severe obesity" in teens, a
condition it said affects about 5% of US children and is increasing nationwide.
The group's threshold for severe obesity is a body mass index of at least 35;
the average BMI in the study was 51.
Because lifestyle changes
and medication rarely work for such obese teens, the statement says obesity
surgery should be considered for those with related health problems who are
psychologically mature enough to handle it.
The new results bolster
evidence from smaller studies in teens and also suggest teens may do better, at
least initially, than adults. Earlier 30-day research in adults found a few
deaths after obesity surgery, although the risk was no greater than for other
major operations. There were no deaths in the teen study.
A three-year follow-up
report on more than 2000 patients in the adult study was also published online in the Journal of the American Medical Association. It showed adults
generally had fewer obesity-related illnesses than in the teen study, and most
weight loss occurred within the first year after surgery. Gastric bypass
surgery, the most common operation in the US, resulted in more weight loss
and more improvement in related illnesses than stomach banding, as other
studies have shown. Three-year death rates were low, and similar for both
procedures, but band patients had many more repeat surgeries.
In the teen study, whether
obesity surgery resulted in lasting weight loss and better health remains to be
seen; the researchers are still following the participants and calculating
But anecdotal reports from
the teens suggest they're doing pretty well.
Chelsea Hale of Cincinnati
has shrunk from 314 to 170 pounds (142 to 77 kilograms) – almost half her
previous size – since having surgery three years ago at age 17 at Cincinnati
Children's. Before surgery, Hale had a hormonal problem, heart blockage and
sleep apnoea – all linked with obesity and all have since subsided.
"I feel good, I can
pretty much physically do anything," said Hale, now in nursing school.
Like 28% of the
teens studied, she had gastric sleeve surgery, which involves removing part of
the stomach and creating a smaller tube or sleeve-shaped stomach. She has to be
careful about eating only small portions of foods, to avoid getting sick, but
said otherwise she has no food restrictions.
bypass or stomach stapling
Some teens in the study say
they can no longer tolerate certain foods, including sugar, meat or dairy
Most teens had gastric
bypass or stomach stapling, which creates a small pouch in the stomach and
attaches it to the intestines. A handful had gastric band operations, in which
surgeons position an adjustable band around the top of the stomach, and inflate
it to shrink the stomach. This operation has not been approved for US teens.
Inge, a pioneer in obesity
surgery in teens, says he does about 30 to 40 operations each year at
Cincinnati Children's and the numbers have increased slightly in recent years.
Kids must be severely obese
to qualify. But many are so large that even when surgery results in substantial
weight loss and better health, they can't shrink their BMI to below the obese
range, Inge said. That underscores the need to find ways to prevent severe
obesity, he said.
University of Colorado
heart specialist Dr Robert Eckel, an American Heart Association spokesman,
said the study shows obesity surgery should be considered a reasonable approach
for kids, but that the study results may represent a best-case scenario, since
surgeons involved were all highly experienced.
Parents seeking obesity
surgery for their teens should have them evaluated in centres that do lots of
these operations, he said.