Study involving Texas Children’s touts weight-loss surgery for teens
Bariatric surgery reversed serious health problems in severely obese teenagers in a large new study, providing the strongest evidence to date that the procedure once considered unthinkable in adolescents provides life-changing benefits for appropriate patients.
The study, conducted at Texas Children’s Hospital and four other pediatric centers, found that three years after undergoing weight loss surgery, teens originally weighing an average of 325 pounds experienced major reductions in their weight and improvements in metabolic health and quality of life. In the most dramatic benefit, type 2 diabetes was cured in 95 percent of study participants.
“I think this data should help make doctors and families realize the option of bariatric surgery is effective and safe,” said Dr. Mary Brandt, director of Texas Children’s Adolescent Bariatric Surgery Program and the leader of the study in Houston. “While further research is needed, intervening early could potentially have more substantial and longer-lasting implications than doing so later in life.”
The benefits of the surgery, which shrinks the stomach and rearranges the intestines, included returning kidney function to normal in 86 percent of study participants, correcting high blood pressure in 74 percent and reversing un-
healthy cholesterol levels in 66 percent. Most of the outcomes were much better than what doctors typically see in older, severely obese patients.
Three years after surgery, the teenagers’ average weight had decreased by 90 pounds, or 27 percent, which Brandt called “a realistic result.” Typically, their weight plateaued after the first year, she said.
The study, which will continue for 10 years, was presented Friday at the Obesity Society annual meeting in Los Angeles and published in the New England Journal of Medicine. It is considered the most comprehensive study ever of teenage bariatric patients, tracking them in numerous psychological, dietary and physical activity categories, in addition to testing outcomes in the laboratory.
About 5 percent of U.S. children and teenagers, or roughly 4.4 million, are severely obese, according to JAMA Pediatrics and the American Heart Association. Definitions of severe obesity depend on age and gender, but a body mass index of 40 or more is often cited. The average body mass index in the study was 53, the classification for a 5-feet, 3-inch tall teenager who weighs 300 pounds.
Previous research has shown that only 2 percent of severely obese teenagers lose weight and keep it off without surgery, said Dr. Thomas Inge, surgical director of the Cincinnati Children’s Hospital’s bariatric surgery program.
Texas Children’s officials said they don’t have good estimates of how many of the nation’s severely obese children and teenagers would be eligible for bariatric surgery, but they said it’s probably a small proportion. They estimated that about 1,600 adolescents undergo the surgery annually.
Among the study’s success stories is Cypress’ Azareth Torres, 21, who had the surgery at 15, when she weighed 300 pounds. She had high blood pressure and was pre-diabetic at the time.
“The surgery made a big difference,” said Torres, at one point down to 200 pounds and now at 220 after having a baby. “I could do a lot more after it — in school and in activities. I’m thankful my mom pushed for it.”
Bariatric surgery has become increasingly common in recent years, but early in the century it wasn’t recommended for adolescents because they are still developing physiologically and psychologically. The new study was designed in part to measure these risk-benefit considerations. When colleagues first suggested Texas Children’s should start performing the surgery in teens, Brandt said, she was aghast.
242 adolescents
The study enrolled 242 adolescents, mostly white females aged 13 to 19. Most had Roux-En-Y gastric bypass surgery, a stomachstapling procedure that reduces the stomach to a small pouch and causes food to bypass the small intestine. Nearly a third had a procedure known as a sleeve gastrectomy, in which the stomach is reduced to about 25 percent of its original size and fashioned into a kind of tube.
The study did show risks. Fewer than 5 percent of study participants had iron deficiencies before surgery, but more than half had low levels afterward. Such deficiencies are a known complication of bariatric surgery — the surgery is designed to cause less absorption of calories but also results in less absorption of vitamins — and requires lifelong vitamin supplementation as a result.
Thirty participants required additional abdominal surgery in the three years following their bariatric surgery, most commonly gall bladder removal.
The study was observational, meaning patients were not randomly assigned to one group getting the surgery and another being treated in other ways. It simply tracked patients who received the surgery.
‘Astounding’ results
Brandt said it is possible that some of the health improvements may not last and that additional health risks could emerge; this is why the study is being conducted over a 10-year period. But she added that some results so far are “astounding,” particularly the effect on diabetes, and said she hopes they lead more doctors and families to choose bariatric surgery and more insurers to cover the procedure.
Brandt said the surgery should be reserved for extremely heavy teens with obesity-related health problems. She also emphasized that she doesn’t believe surgery is the answer for the obesity crisis.
“I feel very strongly that it is a moral imperative that we must take this issue on in a more systematic basis to keep children and adolescents from needing bariatric surgery,” said Brandt. “But for patients with life-threatening disease, this study shows the surgery is effective.”