SAN ANTONIO — Despite the controversy surrounding bariatric surgery for very obese adolescents, appropriate candidates often experience better psychosocial quality of life and improve or reverse obesity-related comorbidities, according to preliminary results of a study at Texas Children's Hospital, Houston.
“This has been one of the most profoundly gratifying things in my career,” said Dr. Mary L. Brandt, director of the hospital's adolescent bariatric surgery program. “They get their lives back.”
Dr. Brandt reported results for 44 severely obese adolescents in an ongoing surgery study. Excess weight loss is 58% at 1 year and 60% at 2 years, she said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
The average age of the 32 girls and 12 boys is 16 years, and average body mass index is 60 kg/m
Surgery improved many of the preoperative comorbidities. For example, 70% of the 44 teenagers had preoperative insulin resistance (and there was an 82% resolution rate) and 91% had sleep apnea (45% resolution rate).
In preliminary results from the National Institutes of Health-funded Teen LABS study, Dr. Brandt and her associates found that type 2 diabetes resolved after surgery for 10 of 11 severely obese adolescents (Pediatrics 2009;123:214–22). Participants had a mean BMI of 50. Surgery was associated with a 34% decrease in BMI, a 41% decrease in fasting blood glucose levels, and an 81% decrease in fasting insulin concentrations.
In the Texas Children's Hospital series, 12 of the 44 patients experienced complications. Two patients had anastomotic bleeding, two had thiamine deficiency, and two had marginal ulcers. One patient each had a retained nasogastric tube, coagulopathy, pulmonary embolism, anastomotic leak, urethral injury, and a Peterson hernia. The complications resolved and there have been no deaths, said Dr. Brandt, professor and vice chair of surgery at Baylor College of Medicine, Houston.
“We are also participating in a second study called TeenView to look at the psychological component—eating disorders and depression especially,” Dr. Brandt said.
“The psychosocial cost of [severe obesity] is not measurable,” she said. Greater depressive symptoms, decreasing competence and self-esteem, and greater poverty are associated with adolescent obesity (Pediatrics 2000;105:e15; N. Engl. J. Med. 1993;329:1036–7).
Dr. Brandt said quality of life for obese adolescents is similar to levels reported by people with cancer during chemotherapy (JAMA 2003:289:1813–9).
She said that bariatric surgery should be considered only for morbidly obese adolescents who meet specific criteria (Pediatrics 2004;114:217–23). It should be limited to children with comorbidities and a BMI greater than 40, according to the recommendations. Candidates are those who have failed to lose weight after at least 6 months of organized attempts, are Tanner stage IV or V, and have supportive families.
Bariatric surgery improved many of the preoperative comorbidities. There was an 82% resolution rate for insulin resistance and a 45% resolution rate for sleep apnea. ©Tina Lorien/