Gastric banding allowed extremely obese adolescents to achieve a more substantial and durable weight loss than did an intensive lifestyle modification program, in a clinical trial with 50 adolescents.
Dr. Paul E. O'Brien of the Centre for Obesity Research and Education at Monash University, Melbourne, and his associates compared the two approaches in adolescents aged 14–18 years with a body mass index above 35 kg/m
The patients were randomly assigned to undergo laparoscopic adjustable gastric binding with follow-up education and guidance or to an intensive nonsurgical intervention program. The program focused on reduced energy intake, increased physical activity (with structured exercise for at least 30 minutes per day), and behavior modification. Subjects received 6 weeks of instruction from a personal trainer and met with a physician, a dietitian, or an exercise consultant every 6 weeks (JAMA 2010;303:519-26).
Of the 25 patients in the surgery group, 24 (96%) completed the full 2 years of follow-up, compared with 18 of the 25 patients in the lifestyle group (72%).
In the surgery group, 21 patients (84%) achieved the primary outcome measure of a loss of at least 50% of excess weight, compared with only 3 (12%) of those in the lifestyle group. At 2 years, the surgery group had lost a mean of 35 kg, or a mean loss of 28% of total body weight. Patients in the lifestyle group lost a mean of 3 kg, or a mean loss of 3% of total body weight, Dr. O'Brien and his colleagues reported.
Metabolic syndrome, present at baseline in 9 surgery patients and 10 lifestyle patients, resolved in all of the surgery patients and in 6 of the lifestyle patients. Similarly, insulin resistance resolved in all patients in the surgery group but persisted in three patients in the lifestyle group.
There were no operative or postoperative complications, and the rates of adverse events were similar between the two groups. Seven patients in the surgery group (28%) required revisional procedures, a finding that the researchers said was not surprising because such revisions are “intrinsic to the gastric banding procedure.”
In an editorial, Dr. Edward H. Livingston, of the University of Texas Southwestern Medical Center, Dallas, said that the 28% rate of revisional procedures is important because the investigators “are among the most experienced group in the world with these operations, suggesting that these complication rates will probably be higher in actual community practice” (JAMA 2010;303:559-60).
Disclosures: The study was supported in part by Allergan, which provided the gastric bands. Dr. O'Brien reported no potential conflicts of interest; one of his associates is a consultant for Allergan and other pharmaceutical firms. Dr. Livingston reported no potential conflicts of interest.