Weight-loss surgery is dramatically more effective for obese teenagers than intense diet, exercise and education programs, according to a new study.
While surgery helps obese adolescents lose weight, the study found it is also linked to a significant reduction in metabolic syndrome and insulin resistance, conditions that increase the risk of serious health problems, including cardiovascular disease and Type 2 diabetes.
The findings, published today in the Journal of the American Medical Association, provide evidence that may help bariatric surgery gain greater acceptance in the medical community as a treatment for some severely obese adolescents as well as adults.
Last week, Toronto's Hospital for Sick Children announced the launch of a new program that will include bariatric surgery in order to help adolescents who are obese because of medical complications or are suffering medical complications as a result of or in conjunction with obesity.
In the new study, researchers in Australia followed two groups of severely obese teenagers that had been randomly assigned to receive either bariatric surgery or participate in an intensive weight-loss program. After two years, they found that 84 per cent of patients who underwent surgery lost more than 50 per cent of their excess weight compared with just 12 per cent in the weight-loss program group.
The lifestyle program involved reduced caloric intake, an exercise schedule and an educational program.
Although lifestyle changes are important, the researchers found surgery is the best way to improve the health of adolescents who are severely obese.
The type of surgery performed in the study is called laparoscopic adjustable gastric banding, a reversible procedure that uses a circular tube filled with saline solution to restrict the size of the stomach, creating a pouch at the top that becomes full quickly. The same type of surgery is being used by the new program at Sick Kids.
However, the Australian researchers, led by Paul O'Brien, director of the Centre for Obesity Research and Education at Monash University Medical School in Melbourne, warn that surgery "is not a quick fix" and requires "long-term supportive follow-up by trained health professionals."
An editorial that accompanies the study says the new research will likely help improve access to bariatric surgery for young people who face serious health problems related to obesity. Edward Livingston, chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center, wrote that while surgery is controversial, in reality it is the most effective way of reducing the risk of lifelong medical complications.
"For these reasons, treating adolescent obesity is important," Dr. Livingston wrote.
Weight-loss experts say there are many misconceptions about weight-loss surgery, such as the notion it's a "quick-fix" solution, and that greater understanding may help ease public acceptance.
Arya Sharma, chair of obesity management at the University of Alberta, said people who have bariatric surgery must carefully time their meals and beverages, and manage the types of food they consume in order to accommodate the restriction to their stomach size. Patients must commit to making changes in order to see weight-loss results and maintain a healthy lifestyle, he said.
In addition, several participants in the new study experienced complications, including procedures to replace their gastric bands.
The issue of weight-loss surgery for adolescents inevitably raises ethical questions and concerns, Dr. Sharma said. But for some, severe obesity is a life-threatening condition that can only be helped through surgery.
Although it's important to focus on prevention, that doesn't help the teens and adults currently battling obesity, Dr. Sharma said, using car accidents as an analogy.
"Even if everybody uses seatbelts all the time, you're going to have people getting into accidents," he said. "You can't say which is more important, that people wear seat belts when you're driving or that we have trauma centres that will give you medical aid."
Yet he has fears there are risks that bariatric surgery could become too common for young people as well as adults. That's one of the reasons Canada's population could benefit from a comprehensive, long-range program aimed at obesity prevention, he said.
"I don't think [prevention is]a high enough priority," Dr. Sharma said.