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Bariatric Procedure Improves Health of Morbidly Obese Teens

New York (May 15, 2009)

Person steps on scale

Teenagers' obesity-related medical complications improve just six months after laparoscopic gastric banding surgery, according to a study by physician-scientists in the Center for Adolescent Bariatric Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital. Their program enrolls 14- to 17-year-old adolescents with morbid obesity and related complications into a clinical trial to evaluate the efficacy of laparoscopic gastric banding (Lap-Band procedure). They found that a small group of extremely obese teenagers who received the Lap-Band procedure as part of the trial lost an average of 20 pounds after six months and had significant improvements in abdominal fat, triglyceride measurements and blood sugar levels as measured by hemoglobin A1c – all risk factors for diabetes and heart disease. The patients' liver function and a measure of immune response also improved. "Extremely obese teenagers have obesity-related health problems, particularly diabetes and increased cardiovascular risk. Laparoscopic gastric banding, which has been shown to be a safe and effective way to lose weight, now offers the possibility of reducing obesity's medical complications," said lead author and pediatric endocrinologist Ilene Fennoy, MD, Medical Director of the Center for Adolescent Bariatric Surgery. "Until recently, these patients have had to rely primarily on non-surgical methods or higher-risk surgeries to lose weight, and few of these treatments have succeeded in achieving major weight loss or greatly improving their overall health."

The Lap-Band procedure, which is approved by the Food and Drug Administration (FDA) for adults but not yet in teenagers, involves making the stomach smaller without staples. Instead, a band is place around the upper part of the stomach, creating a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible. NewYork-Presbyterian Morgan Stanley Children's Hospital is one of three sites in the nation approved to take part in the multidisciplinary FDA-approved Lap-Band Trial for Teens.

Study Results to Date

To date 146 patients have had metabolic evaluations at enrollment into the program – 65 percent of whom are female and 35 percent are male. The ethnically diverse group is 42 percent Caucasian, 33 percent Hispanic, 20 percent African American, and 6 percent other. Of these 146 patients, 40 have had surgery and 23 of those provided six-month follow-up data. The average weight loss for the group at six months was 20.1 pounds with a decline in body mass index from 51.9 to 46.9 kg/m2.

There was improvement in blood pressure as measured by the decline in systolic blood pressure from 122.4 mmhg to 116.3 mmhg (p<0.05) and in acute phase reactants as measured by the decline in ferritin from 63.1 to 52.9 (p<0.05). Lipid parameters and insulin sensitivity measures trended toward improvement as measured by a decline in serum triglyceride from 116.4 to 95.5 (p=0.06), and a decline in whole body insulin sensitivity index (WBISI) from 9.44 to 8.59 (p=0.07), respectively.

The preliminary data suggests changes in insulin dynamics consistent with recent reports of successful treatment of diabetes with the Lap-Band procedure. Further longitudinal data collection is needed to confirm these results and evaluate the impact of this procedure on other comorbidities, such as hypertension, metabolic syndrome, PCOS, and psychosocial outcomes.

Faculty Contributing to this Article:

Ilene Fennoy, MD, Medical Director, Center for Adolescent Bariatric Surgery, and Director, Maxcor POWER (Obesity) Clinic, NewYork-Presbyterian Morgan Stanley Children's Hospital, and Associate Clinical Professor of Pediatrics, Columbia University College of Physicians and Surgeons

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