“Surgery for Obese Children?”

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The Story

“Surgery for Obese Children?”
http://www.nytimes.com/2010/02/16/health/16teen.html
by Laura Beil
The New York Times, February 16, 2010

The Pitch

Stomach surgery for kids: Much enthusiasm, little data

Although still uncommon, surgical weight loss for adolescents is one of the most rapidly growing fields in medicine. Between 2000 and 2003 (the latest year with good data), the number of American teenagers receiving bariatric surgery tripled, to about 800 annually. Most medical experts believe the number today to be much higher, and predict it to be higher still very soon. In addition to a persistent pediatric obesity epidemic, the manufacturer of the Lap Band, which is popular among both surgeons and patients, just applied for approval to market its product among patients younger than 18. Even without FDA approval — which clears the way for billboards and better insurance coverage — adult gastric surgeons are actively recruiting teenage patients . Last month, for example, one Denver practice opened Colorado’s first “Teen Obesity Weight Loss Center.” Evan Nadler of the Obesity Institute at the Children’s National Medical Center in Washington believes that, “in 5 to 10 years you’ll see as many children getting weight loss procedures as adults.”

The trend disturbs many surgeons who see their colleagues lured by a lucrative market and the mistaken assumption that, when it comes to surgery, adolescents are simply small adults. “I don’t think you should permanently do something to a kid unless there’s a good reason to do it,” said Edward Livingston, chief of gastric surgery at the University of Texas Southwestern Medical Center at Dallas. “There is a paucity of really good long term data on this.” This month, in the Journal of the American Medical Association, Australian researchers described a study following adolescents after a Lap Band procedure for two years. The children did indeed lose a lot of weight — but so did a comparison group who simply had very intensive weight-loss therapy. Other studies have also only followed children for an average of two years, finding that most of the health benefits may quickly plateau, improving markedly during the first year, but remaining steady thereafter. Similarly, just-published results from a study of 81 adolescents in Sweden found that one year after surgery, patients had dropped from an average of 293 pounds to 203 pounds. The weight loss ended there: two years later, the
median weight had risen slightly, to 209 pounds.

These are positive results to be sure, but positive enough to irreversibly alter a child’s metabolism? Even surgeons performing the procedure are torn. Texas Children’s Hospital — which began its bariatrics program in 2004, and now maintains one of the busiest centers in the country — turns down 90 percent of adolescents who are seeking gastric bypass, fearing they lack the maturity to follow severe dietary restrictions dictated by the operation. But surgeon Mary Brandt fears other surgeons will take the teens her hospital turns away. “This is an incredibly market-driven surgery,” she said. Last week, Brandt says, one mother called her office to ask about getting a Lap Band for her obese, 8-year-old daughter. “We created something in our society we have to undo.”

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