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Should Obese Children Undergo Lapband Surgery

Gastric banding, a weight-loss procedure less-invasive than gastric bypass surgery, is in high demand for obese Americans. Currently the procedure is legally approved for use in weight reduction for severely obese adults 18 years of age or older.

With a proven success rate in adult patients, why not approve gastric banding for teens? The Food and Drug Administration (FDA) is currently considering that very issue, broadening its standards on gastric banding to include adolescents 14 to 17.

The National Institutes of Health (NIH) initiated an observational study in 2007 to evaluate the benefits and risks of bariatric surgery in adolescents. The purpose of the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is to determine if it is an appropriate treatment option for extremely overweight teens.

A gastric band is just what it sounds like: an inflatable silicone band placed around the top portion of the stomach to create a pouch that restricts food intake. It has become increasingly popular in the United States in recent years, and results in reasonable weight loss. The procedure is considered less invasive and risky than gastric bypass.

Use of the gastric band is especially attractive for use in teens, say supporters, because it is reversible, whereas bypass is not. The laparoscopic procedure takes an hour or less and can be done on an outpatient basis; there is occasional need for a one night hospital stay.

“We know that bariatric surgery is not an easy way out for teens to control weight. They will still need to eat less food and exercise more,” says Mary Horlick, M.D., project scientist for Teen-LABS and director of the Pediatric Clinical Obesity Program of the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the sponsor of Teen-LABS at NIH. “We hope to learn whether or not bariatric surgery is suitable for teens and if it will help them remain at a healthy weight over the long-term.”

The Teen-LABS study is being conducted by researchers at the following medical centers:
*Cincinnati Children’s Hospital Medical Center (Data Coordinating Center and Clinical Center)
*Texas Children’s Hospital, Houston
*Children’s Hospital of Alabama in Birmingham
*University of Pittsburgh, Pennsylvania

The Teen-LABS study researchers are collecting information on the pre-operative and two year post-operative status of the 200 adolescents (aged 14-17), including measures of body composition, body fat, cardiovascular risks, sleep apnea episodes, diabetes indicators, depressive symptoms, quality of life, eating habits, and nutritional status. The study is expected to continue through 2012.

A clinical trial, Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents, published earlier this year in the Journal of the American Medical Association, found that obese adolescent participants having undergone gastric banding resulted in a greater percentage achieving a loss of 50% of excess weight, when compared with lifestyle intervention, diet and exercise, alone. The randomized controlled trial was performed between May 2005 and September 2008 enrolling 50 adolescents between 14 and 18 years with a body mass index (BMI) higher than 35. Participants were recruited from the Melbourne, Australia, and followed for 2 years.

Dr. Roberta Maller Hartman, a psychologist and Lap-Band patient herself, counsels teens and adults after receiving the gastric band. “I’ve worked with a lot of high school students and they just want to be like everyone else and go out and eat pizza with their friends,” she said. “They can, but they have to take little bites and chew a lot.”

Gastric banding demands that teens do something they often aren’t very good at — sticking to a rigorous follow-up routine.

Success depends most on a patient’s ability to modify their behavior. “The band doesn’t reduce the desire to eat emotionally. That has to be addressed,” said Dr. Maller. “Teens tend to need more hands-on, one-to-one support.”

Dr. Santiago Horgan, Chief of Minimally Invasive Surgery at the University of California San Diego Medical Center, believes that eating right with your gastric band is your key to success, and states, “It’s important to review and follow a bariatric surgery diet, as it is critical to your recovery and weight loss success.”

Due to the intensity and importance of the success of the surgery, detailed follow-up instructions are listed:

*First Few Days after Surgery: only sips of water of water, or suck on an ice cube.

*1-2 Weeks Post-Op – Liquid Diet only: water, clear broth, skim milk, fruit juice, sugar-free popsicles.

*3-4 Weeks Post-Op – Pureed Foods Only (baby food consistency): pureed skinless fish or chicken, mashed potatoes, peas, low-fat yogurt or pudding

*5 weeks post-op – Soft Foods: Include tender cooked foods like fish and ground turkey; chew foods well. If you don’t, you may experience vomiting, stomach irritation and swelling. You could also have a stoma obstruction. If solid foods cause nausea and vomiting, go back to the liquid diet. Then, slowly add soft foods and eventually transition to solid foods..

*Nutrition Plan – Solid Foods:
Pay close attention to your diet after lap band surgery. No liquids during or immediately after meals A lot of patients have difficulty with solid foods in the morning. Chew food thoroughly and eat small bits at a time. Eat only three small meals a day and make sure these meals contain adequate nutrients.

*Forbidden Foods (include, but are not limited to):
dried fruits, asparagus, pineapple, rhubarb, corn (especially popcorn), grapes, nuts and seeds, carbonated beverages, high calorie foods/drinks

*10 Important Rules:
1. Only 3 small meals/day
2. Eat Slowly and chew food thoroughly
3. Stop eating as soon as feel full
4. Do not drink while eating
5. Do not eat between meals
6. No Junk Food
7. Drink enough fluids during the day
8. Drink only low-calorie liquids
9. Minimum 30 minutes of exercise/day