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New Study Finds More Obese Teens Undergoing Bariatric Surgery, But May Have Better Post-Operative Outcomes Than Adults

Thursday, March 01, 2007

At a time when there are growing concerns about a national epidemic of obesity among teenagers, a new study focusing on morbidly obese teens who have last-resort bariatric surgery has found that the procedure poses no greater risks for them than for adult patients, and that, in fact, they have a zero death rate and a faster rate of recovery than older patients.

Gastric bypass, stapling or similar procedures known as bariatric surgery is an approach to weight management for morbidly obese patients, which has documented results in improved health outcomes for adults.

Now researchers at the Robert Wood Johnson Medical School and Cincinnati Children's Hospital Medical Center have used data from a large national database to examine nationwide trends from 1996 to 2003 in the use of adolescent bariatric surgery in the first effort to compare the early postoperative results following bariatric surgery in adolescents and adults.

The study, published in the March issue of Archives of Pediatrics & Adolescent Medicine, shows that surgery among teens has tripled in recent years, increasing in the U.S. from an estimate of just over 200 procedures in 2000 to almost 800 procedures in 2003.

"This trend, which seems to parallel the increase in adult bariatric surgery, suggests that the health benefits of bariatric surgery, including reducing the patient's diabetes, sleep apnea and heart disease, for example, are increasingly being recognized by patients and both adult and pediatric health care providers nationwide," said Randall Burd, MD, PhD, a pediatric surgeon and researcher at Robert Wood Johnson Medical School and the study's senior author.

Perhaps even more significant in terms of the use of this surgery, when researchers compared early post-operative results in teens and adults, they found that teens appear to handle the surgery better than adults. The study found that adolescents, ages 12 to 19, had shorter hospital stays and no in-hospital deaths, whereas a 0.2 percent mortality rate was recorded for adults. Morbidly obese adolescents are at risk for type 2 diabetes, sleep apnea and heart disease but the study found they had significantly fewer comorbid conditions prior to bariatric surgery compared to adults.

"This study suggests that the risks for adolescents undergoing weight loss surgery are low and may be even lower than in adults," said co-author Thomas Inge, MD, PhD, FACS, FAAP, surgical director of the Comprehensive Weight Management Center at Cincinnati Children's, one of the largest adolescent-specific bariatric surgery program in the U.S., and associate professor of Surgery and Pediatrics at the University of Cincinnati College of Medicine. "For teens who have tried all other options, it appears that not only can the surgery help them reduce their health risks, but it is possible that risks of the surgery itself are lower for teens because obesity has had fewer decades to damage vital organ systems in the body. We still must carefully monitor short- and long-term outcomes after these procedures to ensure their safety, but this news is reassuring."

At Cincinnati Children's, bariatric surgery is used as a last resort for morbidly obese teens who have tried unsuccessfully to lose weight through diet and / or exercise. More than 70 patients have had bariatric surgery at Cincinnati Children's since the medical center began performing weight loss surgery in 2001. The bariatric research program at Cincinnati Children's has numerous ongoing research studies sponsored by the National Institutes of Health examining the unique metabolic, psychological, and surgical outcomes of teens undergoing weight loss procedures. In addition, an adolescent bariatric research consortium consisting of Cincinnati Children's, Texas Children's Hospital, the Children's Hospital of Alabama, and the University of Pittsburgh Medical Center has recently launched Teen-LABS, a five-year prospective study of teenagers undergoing bariatric surgery.

Dr. Inge noted that the benefits of the surgery for adult patients have been well documented. "Adults with comorbidities of morbid obesity achieve a significant and sustained health benefit from surgical weight reduction," he said, noting that in 1991, this conclusion was embraced by the National Institutes of Health. In addition, the Centers for Medicaid and Medicare Services of the Department of Health and Human Services last year determined that costs for surgical weight loss procedures should be covered by Medicare because of strong evidence of the benefits achievable from these procedures. The improvements in health outcomes which have been documented following adult surgery have increasingly led clinicians to consider surgery for adolescents with severe complications of morbid obesity.

The new study also compared the costs of surgery for adults and teens, finding that adolescents had lower hospital charges. Total hospital charges in 2003 for adolescents undergoing bariatric surgery were $23.6 million and for adults was $3.8 billion. The average hospital charges associated with these procedures were 15 percent lower for adolescents than for adults. Similar to adults, most adolescents had private insurance.

Although bariatric surgery among adolescents has increased, it is by no means a common procedure, representing fewer than one percent of the bariatric procedures performed nationwide. The study found that although the majority of surgery recipients are female, more male adolescents are requesting it.

One Patient's Experience

Eric Decker, now 21 years old, had bariatric surgery at Cincinnati Children's at age 17. At 11 Decker began struggling with his weight. Taunting as a child led to depression and even more weight gain. By sixth grade, he was 190 pounds and began Weight Watchers but fell off the wagon every time. As a 16-year-old, he eventually reached 5'10" and 385 pounds. It was then that he was inspired by Carnie Wilson to go through the gastric bypass surgery. "Looking back on it now, I wouldn't want to go through the pain again but it was well worth it," said Decker, who speaks about the risks and benefits to other adolescents considering bariatric surgery at Cincinnati Children's. As a current broadcast journalism major at the University of South Carolina, Decker has remained very healthy, and continues a strict diet and fitness regimen. "It's been four years since my surgery and I feel better than ever. Because of my excess skin, I have to choose clothes carefully but many people don't realize I've had the surgery until we sit down for dinner and all I can eat is a salad and a few bites of my meal. I realize it's a lifelong process but my health is worth it. I'd like to be around for a long time to fulfill my dreams."

About Cincinnati Children's

Cincinnati Children's Hospital Medical Center, one of the leading pediatric research institutions in the nation, is dedicated to changing the outcome for children throughout the world. Cincinnati Children's ranks second among all pediatric institutions in the United States in grants from the National Institutes of Health. It has an established tradition of research excellence, with discoveries including the Sabin oral polio vaccine, the surfactant preparation that saves the lives of thousands of premature infants each year, and a rotavirus vaccine that saves the lives of hundreds of thousands of infants around the world each year. Current strategic directions include the translation of basic laboratory research into the development of novel therapeutics for the treatment of disease, and furthering the development of personalized and predictive medicine.