Surgery for Adolescents

Like obese adults, obese adolescents face a high risk of serious medical disorders, including hypertension, diabetes, respiratory disorders, accelerated growth, high cholesterol, musculoskeletal problems, psychosocial problems, and cancer, as well as a greater chance of premature death. Unfortunately, obesity is rarely something children "grow out of." Obese children become obese adults.

Thus, it is imperative to address obesity at an early age. However, there is little data available to guide parents and physicians who are trying to help morbidly obese adolescents.

At present, there is only one surgical option for morbidly obese adolescents: Roux-en-Y gastric bypass. This procedure has been shown to be both safe and effective in adolescents, with substantial reductions in weight and improvements in co-morbid conditions and psychosocial factors like self-esteem and socialization.

We believe that laparoscopic adjustable gastric banding would be a better option for ther teenager, mainly because it is much less invasive than gastric bypass and the band can be removed after sufficient weight loss and behavior modification. To test this hypothesis, NYU is currently conducting a clinical trial comparing the benefits of gastric banding surgery with that of gastric bypass surgery in adolescents. NYU is one of only two institutions allowed to perform gastric banding surgery on this patient population.

Studies performed in Australia have shown that gastric banding is a safe and effective method of weight loss in morbidly obese adolescents. In fact, when compared to matched controlled adults, adolescents did better in terms of weight loss and complications.

How young is too young? Relatively little is known whether there is a safe lower age limit for gastric banding surgery. One of the obvious concerns in offering surgery to children as young as 12 is that it might have a deleterious effect their growth. However, there are data that suggest that bariatric surgery would not affect normal development, since they tend to be above average in various growth categories. Obese children are known to grow faster than non-obese children. They are taller by at least one standard deviation than their normal weight peers before puberty, and then normalize in their late teens. Furthermore, they have higher-than-normal levels of lean body mass and fat mass for their height. Obese girls achieve puberty at a younger age than non-obese girls.