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Surgery may help very obese teenagers

Study finds it more effective

By Jason Gale
Bloomberg News / February 11, 2010

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SINGAPORE - Weight-loss surgery was more effective at slimming severely obese teens and improving their health than two years of diet and exercise, a study found.

Adolescents fitted with Allergan’s Lap-Band device lost about 11 times more weight than a group following so-called lifestyle approaches, researchers in Melbourne said. The results reported yesterday in the Journal of the American Medical Association suggest bariatric surgery is an effective treatment for younger obese patients, the authors said.

Weight-loss surgery has soared in popularity among adults in the United States in response to rising rates of obesity. The procedure has been controversial because the quality of evidence to support it is poor, said Edward Livingston, professor of surgery at the University of Texas Southwestern Medical Center in Dallas and a contributing editor to the journal.

The study’s findings “go a long way toward providing the evidence necessary to evaluate the benefits and risks of bariatric surgery,’’ Livingston wrote in an editorial. “Many insurance companies in the United States will not pay for bariatric surgeries, and their decision to not cover this treatment is based on the lack of compelling, universally accepted evidence in its favor.’’

At least one US adolescent in six - more than 5 million people - was obese in 2004, according to the study. Michelle Obama began a nationwide campaign Tuesday against childhood obesity and announced the creation of a website, www.letsmove.gov, which will offer information on exercise and healthy eating to children, parents, and schools.

The number of obese Americans has more than doubled over 30 years to 72 million, according to the Centers for Disease Control and Prevention. People who are overweight or obese have a greater risk of diabetes, heart attacks, and strokes, the Atlanta-based agency said last month.

Allergan is testing the device in severely obese adolescents ages 14 to 17 and submitted an application to the Food and Drug Administration for approval in that age group, she said.

For the study, researchers at Melbourne’s Monash University followed 50 adolescents ages 14 to 18 over two years. All participants were severely obese, having a body mass index, or BMI, greater than 35. Half were randomly selected for gastric banding, and the remainder was asked to follow an individualized diet and exercise plan.

Gastric banding is done when a surgeon places a band around the upper portion of the stomach to create a pouch to hold food, which limits the amount a person can eat. The reversible procedure is one of the two most common for weight loss, with the other being gastric bypass.

In the study, two years after the start, the gastric banding group had lost an average of 76 pounds, representing an overall average loss of 28 percent of total body weight and 79 percent of excess weight, the researchers said. In comparison, the lifestyle group lost an average of 6.6 pounds, or an average of 3.1 percent total weight loss and 13 percent excess weight loss.

“Despite a comprehensive, behaviorally focused intervention, those in the lifestyle group were not able to achieve substantial weight loss,’’ wrote the study’s authors led by Paul O’Brien, 66, director of Monash’s Centre for Obesity Research and Education. “Keeping adolescents and their parents involved in the trial for its two-year duration proved challenging.’’

Allergan supplied the Lap-Band Adjustable Gastric Banding system used in the research.

The study was not designed to measure improvements in specific health problems, but it demonstrated a reduction in a group of conditions associated with increased risk for cardiovascular disease and diabetes.

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