Stomach bypass surgery helps some obese teens

Surgery to reduce the stomach’s size is often seen as a last resort for severely obese teenagers, partly because there has been little information on the procedure’s long-term effects on young people. Surgery Helps Some Obese Teens In Battle To Get Fit

But a study published online Friday in the New England Journal of Medicine tracked teens for three years and suggests that bariatric surgery as part of a weight-reduction plan was not only safe, but increased

their heart health and the quality of their lives.

Dr. Thomas Inge, a surgeon at Cincinnati Children’s Hospital Medical Center, led the study of 242 severely obese adolescents who underwent the surgery.

The young people were between 13 and 19 years old and averaged 325 pounds at the start of the study, Inge says. Surgery helped them lose nearly a third of their original body weight and maintain that loss for three years. Even more importantly, Inge says, the development of obesity-linked disease was stopped in its tracks.

Of teens who had Type 2 diabetes when they underwent the surgery, “95 percent of them had no sign of diabetes at three years,” Inge says. Most participants in the study also dramatically reduced their blood pressure after surgery, and had improved kidney function and less blood fat.

The hope is that these sorts of improvements in physical markers will ultimately translate to fewer strokes, heart attacks and other disabilities down the road, he says. Previous research has suggested that only about 2 percent of severely obese teens are able to lose weight and keep it off without surgery.

Adults who have weight-loss surgery also see reductions in diabetes, blood pressure and blood fat, Inge says. But the improvements aren’t as dramatic — perhaps, he says, because it’s easier to tame a disease that hasn’t already had years to do damage.

The teens also experienced a big jump in their confidence.

“I think it’s one thing to talk about what this does to their blood pressure and diabetes,” Inge says. “It’s a whole other thing, when you’re in the patients’ shoes, to be able to talk about how they feel after the operation.”

The answer, he says, was unmistakably good — so good that some kids made a few other bold changes in their appearance, taking deliberate steps to stand out instead of trying to hide.

“It’s very much the routine to see them expressing themselves and saying, ‘Here’s me with green hair color, pink hair color,” Inge says. “It’s telling the world, ‘This is the new me, and I like it!’ And, ‘Here we are!’ ”

The surgery isn’t without side effects and these, too, showed up in the study. In addition to the risks of any surgery, bariatric surgery alters how the body digests food — so most of the teens also had to start taking vitamin and iron supplements after the procedure. And about 13 percent wound up needing additional abdominal surgery — most commonly gall bladder removal.

These teenagers and others need continued follow-up to be certain that benefits outweigh risks as the years go on, Inge says. But at least now, teens — and their parents and doctors — are starting to get a little more solid information to help guide choices about treatment. Stomach bypass surgery shows dramatic long-term improvement in obese teens

Giving stomach bypass surgery to severely obese teens cuts their weight by an average of 27 percent while often eliminating high blood pressure, cholesterol problems, abnormal kidney function and diabetes, according to doctors behind a large study that followed the adolescents for three years.

The dramatic improvements are tempered by the fact that 13 percent required additional surgery – usually to have their gall bladder removed – and more than half had low iron levels, a problem solved with vitamin supplements.

“When you are the parent of a morbidly obese teen and you are contemplating surgery, it’s reassuring to see a large study like this that gives you a little more peace of mind that this intervention is safe and effective,” chief author Dr. Thomas Inge, surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center, told Reuters Health in a telephone interview.

The outcomes in these adolescents were, in many ways, better than what doctors see after they perform so-called bariatric surgery on older obese patients.

In studies of adults, “high blood pressure was reversed in 38 percent, whereas we’re finding high blood pressure was reversed in 74 percent of our teenagers,” Dr. Inge said. Perhaps 60 percent of adults see a remission in their diabetes “and we’re seeing over 90 percent. The good news is, we may be describing the benefit of early intervention.”

The results, presented Friday at The Obesity Society annual meeting in Los Angeles and published online by The New England Journal of Medicine, are based on the largest long-term study of stomach bypass surgery done on a group of teens.

At five U. S. centers, 242 adolescents ages 13 to 19 were enrolled. Most were white females. They had an average body-mass index (BMI) of 53, which would, for example, be a 5’3″ teenager who tips the scale at 300 pounds.

“They’re at the very top of the severely obese,” said Dr. Inge.

All were treated with one of two bypass procedures. There was no control group.

After three years, their average weight had gone from 325 pounds before surgery to about 240.

Thus, most were still obese, with an average BMI of 38. But 95 percent who had diabetes at the start of the study no longer had it, 86 percent saw a remission in their abnormal kidney function, 74 percent no longer had high blood pressure and 66 percent no longer had cholesterol problems.

“The reversal of diabetes was remarkable at 95 percent. That’s more than what we would expect from adults,” Dr. Inge said.

BMI is a ratio of weight to height. People with a BMI of 30 and higher are considered obese, and those over 35 are ranked as severely obese.

“If you did very well at a BMI of 53, I would think it’s safe to say you could expect the same benefit if you’re operating on a BMI of 35 or 40,” said Dr. Inge.

“Perhaps there’d be even more benefit” in that range, he speculated. “We only got 25 percent of these patients to a non-obese BMI” and earlier intervention might improve that rate.

The rate of side effects was not unexpected, he said.

When it comes to requiring subsequent surgery, particularly surgery to remove the gall bladder, Dr. Inge said being obese is a risk factor for having gallstones, as is rapid weight loss. The rate seen in the study “was no different from what we would expect in an adult as well.”

The same was true for low iron levels.

“Nothing big and scary is popping up to suggest these kids are on a negative trajectory for nutrition,” the researcher said.

Many teens might consider the risk worth it.

“We did see the patients telling us, in their own way, that their quality of life improved,” said Dr. Inge. “When you have kids who are not able to fit into desks, who can now fit into their environment, that’s very meaningful on a day to day basis. We really saw a dramatic improvement in the physical comfort and self esteem after surgery.”

“If sustained, the improvements seen in weight, blood sugar, kidney function, blood pressure, and lipid levels may translate into fewer strokes, heart attacks and other disabilities later in life,” he said in a news release.

The patients will continue to be followed until 10 years has elapsed as part of the study, known as Teen-LABS.

Filed under: Health News

Tags: obesity

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