Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial.
BACKGROUND
Adolescent obesity is a common and serious health problem affecting more than 5 million young people in the United States alone. Bariatric surgery is being evaluated as a possible treatment option. Laparoscopic adjustable gastric banding (gastric banding) has the potential to provide a safe and effective treatment.


OBJECTIVE
To compare the outcomes of gastric banding with an optimal lifestyle program on adolescent obesity.


METHODS
A prospective, randomized controlled trial of 50 adolescents between 14 and 18 years with a body mass index (BMI) higher than 35, recruited from the Melbourne, Australia, community, assigned either to a supervised lifestyle intervention or to undergo gastric banding, and followed up for 2 years. The study was performed between May 2005 and September 2008.


METHODS
Weight loss. Secondary outcomes included change in metabolic syndrome, insulin resistance, quality of life, and adverse outcomes.


RESULTS
Twenty-four of 25 patients in the gastric banding group and 18 of 25 in lifestyle group completed the study. Twenty-one (84%) in the gastric banding and 3 (12%) in the lifestyle groups lost more than 50% of excess weight, corrected for age. Overall, the mean changes in the gastric banding group were a weight loss of 34.6 kg (95% CI, 30.2-39.0), representing an excess weight loss of 78.8% (95% CI, 66.6%-91.0%), 12.7 BMI units (95% CI, 11.3-14.2), and a BMI z score change from 2.39 (95% CI, 2.05-2.73) to 1.32 (95% CI, 0.98-1.66). The mean losses in the lifestyle group were 3.0 kg (95% CI, 2.1-8.1), representing excess weight loss of 13.2% (95% CI, 2.6%-21.0%), 1.3 BMI units (95% CI, 0.4-2.9), and a BMI z score change from 2.41 (95% CI, 2.21-2.66) to 2.26 (95% CI, 1.91-2.43). At entry, 9 participants (36%) in the gastric banding group and 10 (40%) in the lifestyle group had the metabolic syndrome. At 24 months, none of the gastric banding group had the metabolic syndrome (P = .008; McNemar chi(2)) compared with 4 of the 18 completers (22%) in the lifestyle group (P = .13). The gastric banding group experienced improved quality of life with no perioperative adverse events. However, 8 operations (33%) were required in 7 patients for revisional procedures either for proximal pouch dilatation or tubing injury during follow-up.


CONCLUSIONS
Among obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage achieving a loss of 50% of excess weight, corrected for age. There were associated benefits to health and quality of life.


BACKGROUND
ANZCTR Identifier: 12605000160639.
O'Brien
Paul E
PE
Centre for Obesity Research and Education, Monash University Medical School, Alfred Hospital, Melbourne, 3004, Australia. paul.obrien@med.monash.edu.au
Sawyer
Susan M
SM
Laurie
Cheryl
C
Brown
Wendy A
WA
Skinner
Stewart
S
Veit
Friederike
F
Paul
Eldho
E
Burton
Paul R
PR
McGrice
Melanie
M
Anderson
Margaret
M
Dixon
John B
JB
D000293:Adolescent; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006304:Health Status; D006801:Humans; D010535:Laparoscopy; D008019:Life Style; D008297:Male; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation; D016896:Treatment Outcome; D015431:Weight Loss