• Diabetes & Endocrinology Clinical Trials
• Obesity

Data from a study of morbidly obese adolescents show that significant weight loss is achievable in a large percentage of adolescents following laparoscopic gastric banding. In addition, significant metabolic improvement is likely when at least 20% of excess body weight is lost. Shulamit E. Lerner, MD, Columbia University Medical Center, New York, New York, USA, reported the results of the study.

The rate of severe childhood obesity has tripled in the past 25 years, which has profound implications for the early-adult onset of cardiovascular disease and diabetes. Dietary interventions have typically resulted in limited weight loss (up to 10% of total body weight), leaving surgical interventions as the best options for morbidly obese adolescents [Skelton JA et al. Acad Pediatr 2009]. With gastric bypass surgery the standard of care for this population, the frequency of laparoscopic gastric banding has increased since 2005 [Jen HC et al. Pediatrics 2010].

The aim of the study was to determine the preoperative anthropometric and metabolic parameters that predicted significant weight loss after banding and the metabolic outcomes that are associated with significant weight loss. The study involved 63 adolescents who were followed up for at least 1 year after surgery. Thirty-eight of the 63 (9 male and 29 female) subjects lost an average of 50.5% excess body weight (29.7 kg), and 25 (12 male and 13 female) subjects lost an average of 2.9% excess body weight (3.2 kg). The investigators evaluated the findings by analyzing and comparing the data from two groups of patients according to weight loss: those who lost at least 20% of excess body weight with those who had lost less than 20% of excess body weight.

Dr. Lerner said that predictors of weight loss were drawn from data that were collected at the patients' initial visits. Several factors were significant predictors of weight loss of at least 20% of excess body weight, including older age, taller height, lower body mass index (BMI) and BMI z-score, waist circumference/height, 30-minute glucose and 120-minute insulin levels on an oral glucose tolerance test, 1,25 dihydroxy vitamin D level, and no history of polycystic ovary syndrome; these factors were predictive at a significance of 0.01<p< 0.05.

Thus, the ideal adolescent patient for gastric banding is characterized by achievement of 95% of final height, based on bone age assessment; a BMI >30 to 40 kg/m² with significant obesity-related comorbidity or BMI >40 kg/m² in the presence of milder obesity-related comorbidity; demonstration of ability to adhere to a lifestyle modification program prior to surgery and to both comprehend and be able to cope with nutritional and behavioral ramifications of bariatric procedures; no presence of eating disorders or other psychiatric illnesses, such as depression or exposure to abuse; and a supportive family environment [Keidar A et al. Curr Opin Clin Nutr Metab Care 2011].

Among the adolescents who lost at least 20% of excess body weight, decreased glucose and insulin levels on oral glucose tolerance test, lower systolic and diastolic blood pressures, alkaline phosphatase, uric acid, and sex hormone-binding globulin, and higher levels of high-density lipoprotein (p<0.05) were observed. These data indicate the potential for improved metabolic parameters for morbidly obese adolescents who lose at least 20% of excess body weight.

• © 2011 MD Conference Express