Debate over gastric surgery for teens
A new Australian study has found obese teenagers who have gastric band surgery lose more weight than those on a diet, but critics warn the procedure is risky and should only be used as a last resort.
The study, led by Monash University's Centre for Obesity Research and Education, appears today in the Journal of the American Medical Association.
The study placed 25 obese teenagers on a supervised weight loss regime, while another 25 were given gastric banding surgery to suppress their appetite.
Study author Associate Professor John Dixon, says those on a diet lost an average of 3 kilograms, while those who underwent surgery lost an average of 35 kilograms.
Critics have argued having surgery to stop obesity sends the wrong message for young people, but Dixon says the benefits outweigh the risks of surgery.
"This isn't drastic treatment. This is surgery that you can have done in the same day. It is very safe surgery and the effects on ill children and adolescents are profound," he says.
Dixon says gastric banding could lower the risk of future disease and provide a better quality of life.
"I am comfortable with having those who are most ill treated. I think we should always treat those who are most ill."
But critics of the study believe it glosses over the risks and sends the wrong message to the public.
According to the study, one third of those who received the gastric banding required follow-up surgery during the two-year study period.
Two of the patients received injuries during adjustments to the band, while six suffered "proximal gastric enlargement".
"That's a real concern," says adolescent health expert Associate Professor Jeff Walkley of RMIT University in Melbourne.
"[The surgery] is not risk free. It places the children in contact with risk and clearly what we want to do is to reduce the amount of risk," he says.
"It's clear that it leads to dramatic weight loss, but it's less clear whether from a long-term perspective - not just two years, but five or ten years - whether there will be any adverse outcomes."
Walkley also believes the study will send the wrong message to obese adolescents and their families.
"What concerns me is that this will raise the expectation that the most viable and accessible approach is to have surgery," he says.
"We should continue to explore vigorously other forms of non-invasive approaches to support adolescents and their families to lead a lifestyle where a natural outcome is an appropriate bodyweight."
Walkley says the study may be biased as it failed to provide adequate support to the non-surgery group.
"They recommended 30 minutes of activity a day plus 10,000 steps," he says. "[But] the current recommendation set for kids who are not overweight or obese in Australia is 60 minutes of physical activity daily."
Walkley also says there is no evidence of any therapy aimed at changing eating behaviour or lifestyle.
"I think that they should have the best available lifestyle program, and based on what I've read I can't interpret they did that."
Vice-President of the Australian Medical Association, Dr Steve Hambleton, also warns against children undergoing gastric banding.
He says the procedure is a last resort and should not be looked at as an easy way out.
"We shouldn't be outsourcing self control to a surgical procedure. It means we're not doing anything about the problem, just treating the symptoms."
In the study, Dixon discloses that he has a consultancy with Allergan, the manufacturer of the bands used in the trial, and is a member of the Allergan diabetes advisory board. The study's lead author, Professor Paul O'Brien is a former Allergan advisory board member.
The study was funded by the National Health and Medical Research Council; however, according to the Centre for Obesity Research and Education's 2008 annual report, Allergan is a major funding source.