Teens undergoing weight-loss surgery in California are increasingly opting for adjustable gastric band procedures instead of stomach-shrinking gastric bypass surgeries, a new study finds.
But because the gastric bands, which divide the stomach into two sections and reduce the amount of food a person can eat, are not yet approved for use in teenagers by the Food and Drug Administration (FDA), researchers caution that more study is needed on the surgery's safety and effectiveness.
Weight-loss, or bariatric, surgery in teenagers is relatively rare, but the number of procedures has increased dramatically in recent years. One 2008 study, published in the Journal of the American College of Surgeons, estimated that the number of teen bariatric surgeries performed nationally increased five-fold between 1997 and 2003.
However, little is known about what kind of bariatric surgeries teenagers are getting. To find out, researchers from the University of California, Los Angeles, gathered data from hospital, ambulatory surgery centers and emergency department databases in California. They counted patients under 21 years of age who underwent surgery between 2005 and 2007. That age group contained 18, 19 and 20-year-olds for whom the surgery is FDA-approved, and 13 to 17-year-olds for whom it is not.
Demographics of surgery
Overall, 590 adolescents got bariatric surgery in California between 2005 and 2007. White girls were the most common surgery patients: While 43 percent of the overweight teenagers in California are female, 78 percent of the teenage surgical patients were girls. And while more than half of overweight Californian teens are Hispanic, only 21 percent of those who underwent surgery were. Whites accounted for more than 65 percent of teen bariatric surgeries, the study found.
The demographics mirror trends in adult weight-loss surgery, said study co-author Daniel deUgarte, a pediatric surgeon at the Ronald Reagan UCLA Medical Center and Santa Monica-UCLA Medical Center and Orthopedic Hospital.
"Whether or not that reflects issues related to insurance status, cultural factors, socioeconomic factors or other biases by surgeon or by patient or by referring physician, is unclear," deUgarte said.
Band over bypass
The rates of surgery stayed stable over the years studied, but the types of surgeries performed shifted dramatically, the researchers report Sept. 20 in the journal Pediatrics. Laparoscopic gastric bypass — in which surgeons insert tools through small incisions in the abdomen to create a small pouch in the stomach, allowing food to "bypass" the rest of the stomach — decreased in popularity from 3.8 surgeries for every 100,000 Californian teens to 2.7.
But while gastric bypass rates dropped, rates of gastric banding went up five times, from just 0.3 surgeries per 100,000 teens to 1.5. These surgeries, often called "lap-band" procedures, involve placing an adjustable silicon band around the stomach, constricting it. Only 18 percent of the surgeries were performed on teens under 18, but the gastric band overtook gastric bypass in the young age group.
Gastric band surgery may appeal to teens because of an intense marketing campaign by manufacturers, the researchers wrote. The adjustability and possible reversibility may also appeal to young people, deUgarte said. Insurance concerns may also drive surgery choices: Those who were paying for their own procedures were more likely to get gastric band surgery (it’s less expensive).
The study found that complication rates of weight-loss surgery were on par or better than other common surgeries, though the researchers lacked data on how well the surgeries worked. The band has yet to be approved for patients under 18, though the FDA is currently reviewing data from a manufacturer study on the surgery in teens. Another study, funded by the National Institutes of Health, is investigating long-term weight loss and health in teens who get bariatric surgery.
The theory, said Marc Michalsky, an investigator on both the manufacturer and NIH studies and the surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, is that bariatric surgery in youth will help obese teens avoid a lifetime of illness.
"If a patient undergoes one of these operations early, during their teenaged years, the result may be that they avoid the development of chronic obesity-related diseases that can result in permanent organ damage," he said.
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