SAN ANTONIO — Despite the controversy surrounding bariatric surgery for very obese adolescents, appropriate candidates often experience better psychosocial quality of life and improve or even reverse obesity-related comorbidities, according to preliminary results of a study at Texas Children's Hospital in Houston.
“This has been one of the most profoundly gratifying things in my career,” said Dr. Mary L. Brandt, director of the hospital's adolescent bariatric surgery program. “They get their lives back.”
Dr. Brandt reported results for 44 severely obese adolescents participating in an ongoing surgery study. Excess weight loss was 58% at 1 year and 60% at 2 years, she said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
The average age of the 32 girls and 12 boys is 16 years, and average body mass index is 60 kg/m
Surgery improved many of the preoperative comorbidities. For example, 70% of the 44 teenagers had preoperative insulin resistance, and 82% of these experienced resolution of the condition; 91% had sleep apnea, which resolved after surgery in 45%.
In preliminary results from the National Institutes of Health-funded Teen LABS study, Dr. Brandt and her associates found that type 2 diabetes resolved after surgery in 10 of 11 severely obese adolescents (Pediatrics 2009;123:214-22). Surgery was associated with a 34% decrease in BMI, a 41% decrease in fasting blood glucose levels, and an 81% decrease in fasting insulin concentrations.
In the Texas Children's Hospital series, 12 (27%) of the 44 patients experienced complications. Two patients experienced anastomotic bleeding, two had thiamine deficiency, and two had a marginal ulcer. Complications that occurred in one patient each included a retained nasogastric tube, coagulopathy, pulmonary embolism, anastomotic leak, urethral injury, and a Peterson hernia. All the complications resolved and there have been no deaths, said Dr. Brandt, professor and vice chair of surgery at Baylor College of Medicine in Houston.
“We are also participating in a second study called TeenView to look at the psychological component—eating disorders and depression especially,” Dr. Brandt said. Changes in body shape satisfaction, social support, and peer victimization/teasing will be assessed.
Other researchers have demonstrated that greater depressive symptoms, decreasing competence and self-esteem, and greater poverty are associated with adolescent obesity (Pediatrics 2000;105:e15; N. Engl. J. Med. 1993;329:1036-7).
Dr. Brandt said quality of life for obese adolescents is similar to levels reported by people with cancer during chemotherapy (JAMA 2003;289:1813-9).
She emphasized that bariatric surgery should be considered only for morbidly obese adolescents who meet specific criteria (Pediatrics 2004;114:217-23). These procedures should be performed only in centers that can provide multidisciplinary evaluation and treatment, Dr. Brandt said. And because the long-term risks are not completely known, all adolescents who have bariatric surgery should be enrolled in a prospective outcomes study.