What’s my advice to my overweight patients? Eat less and exercise more. I give this advice every day, but following this advice is much harder than giving it. Overweight people frequently struggle with diet and exercise for years, sometimes successfully, sometimes regaining their previously lost weight.
And as we become more overweight as a nation, obesity is no longer just a problem for adults. Over 5 million adolescents are estimated to be obese in the US, which predicts bad things for their likelihood of developing diabetes, high blood pressure and other health problems. Being an obese teen can also be a serious social and psychological burden. Anyone who remembers adolescence knows that teens aren’t always accepting, nurturing and ethical peers.
I’ve written in the past about the slowly amassing scientific evidence that surgery for obesity has definite health advantages over continued attempts at diet and exercise. This week, that evidence is extended to adolescents.
A study published in this issue of The Journal of the American Medical Association enrolled 50 teenagers between 14 and 18 years of age with a body mass index (BMI) higher than 35. (For a person who is 5 feet 8 inches tall, a BMI of 35 means a weight of 235 lb.) The enrolled teens also had to have been attempting to lose weight through diet and exercise for more than 3 years.
The teens were randomized to two groups. One group underwent laparoscopic gastric banding. In this surgery, an inflatable plastic belt is wrapped around the upper part of the stomach, decreasing how much food can be ingested. In post-operative follow up the band can be adjusted by inflating or deflating it, thereby calibrating how much it constricts the stomach. The second group was randomized to a supervised lifestyle intervention involving an individualized diet plan and a structured exercise program. The groups were followed for two years.
The results were dramatic. The group that underwent gastric banding lost an average of 76 lb over two years, compared to an average 7 lb in the lifestyle modification group. The group that underwent gastric banding also had a higher quality of life and improvement in other health-related measurements.
The authors were quick to caution that gastric banding is no “quick fix”. Patients still have to eat differently and be willing to have periodic follow up, potentially forever. The authors still recommend diet and exercise as the first choice for weight loss. But now for the many teens who do not lose weight after many attempts, there is a proven alternative.
Wall Street Journal article: Weight-Loss Surgery for Obese Teens Backed by Study
Journal of the American Medical Association study: Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents
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