Center for Adolescent Bariatric Surgery performs 100th LAGB procedure

Few treatments are available to help obese adolescents who are unable to lose weight and are already suffering from obesity-related health problems. Laparoscopic adjustable gastric banding (LAGB), an option for adults in the United States since 2001, is showing promise for teens. The Center for Adolescent Bariatric Surgery, which opened at NewYork-Presbyterian Morgan Stanley Children's Hospital in 2006, recently performed its 100th LAGB procedure.

"Adolescent obesity continues to be under-treated," says Dr. Charles J.H. Stolar, surgeon-in-chief at NewYork-Presbyterian Morgan Stanley Children's Hospital and chief of the Division of Pediatric Surgery, and the Rudolph N. Schullinger Professor of Surgery at Columbia University College of Physicians and Surgeons. "We know that obese 14- to 18-year-olds are at risk for significant and even fatal conditions as they grow older. In cases where medical therapy doesn't work, surgery is an effective treatment option."

"Our program prefers to perform LAGB rather than other types of bariatric surgery because this technique has been shown to be the safest and least traumatic," says Dr. Jeffrey L. Zitsman, director of the Center for Adolescent Bariatric Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital and associate professor of surgery at Columbia University College of Physicians and Surgeons. "It does not reroute patients' digestive anatomy, is completely reversible, and the laparoscopic technique is minimally invasive."

The band slows the passage of food through the stomach so that a person is hungry less often, feels full more quickly and longer, eats smaller portions, and loses weight over time.

According to Dr. Zitsman, nearly 90 percent of adolescents with a body mass index (BMI) greater than 40 are ultimately unable to achieve or maintain adequate weight loss despite intensive medical regimens. The National Institutes of Health (NIH) considers a BMI of 25 overweight, while 30 or above is considered obese. The average pre-operative BMI for adolescents undergoing LAGB at the Center for Adolescent Bariatric Surgery is about 48, although patients with a pre-operative BMI of 35 may undergo surgery if they are already suffering from diabetes or obesity-related illnesses.

"Although the average age of our patients is younger than 17 years, with BMIs this high they are already having significant health issues," Dr. Zitsman says. "Many have elevated cholesterol, hypertension, heart problems, joint problems, and markers for insulin resistance. Girls have irregular periods and polycystic ovary syndrome. By interrupting the progression of health problems while these patients are still young, we hope to prevent irreversible damage and improve their lifelong health prospects."

Bariatric surgery has not been performed as commonly in adolescents largely because the long-term consequences have not been fully studied. The Center for Adolescent Bariatric Surgery is one of only four U.S. centers that are part approved by the FDA currently evaluating the outcomes of LAGB in teens.

All potential surgical candidates undergo a comprehensive assessment by a team that includes a pediatrician, a pediatric endocrinologist, a gastroenterologist, a pulmonologist, a psychiatrist, an exercise physiologist, a nutritionist, a bariatric surgeon, an anesthesiologist, and a pediatric nurse practitioner. Before they can be considered candidates for LAGB, patients must complete a program of thorough screening and comply with rigorous weight-loss education and therapy.

Although LAGB is showing promise for helping morbidly obese youngsters lose weight, it should not be thought of as a magic bullet but rather another tool in the arsenal.

"Our initial numbers show that about a year after surgery, most of our patients have lost about one-third of their excess body weight. We have a few patients who have even lost 100 percent of their excess weight after two years," Dr. Zitsman says. "But even with surgery, the patient and his or her family still have to make a real commitment to changing what the youngster eats and to making certain lifestyle changes."

Recently, researchers from the Center for Adolescent Bariatric Surgery found that obese adolescents who had undergone LAGB showed improvement in metabolic syndrome. This syndrome includes a number of risk factors -- high blood pressure; low levels of HDL or good cholesterol; excessive abdominal fat; and elevated levels of blood sugar, C-reactive protein and triglycerides -- that increase the chances of developing cardiovascular disease or diabetes later in life. The single biggest risk factor is obesity; metabolic syndrome usually improves when a person loses weight.

"With the rise of adolescent obesity in the U.S. to nearly 20 percent and with all the complications that come from this condition, understanding the role for banding surgery in adolescents is critical," Dr. Zitsman says.