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Sunday, February 14, 2010

Treating Obese Teenagers

Teenagers who are obese may now be able to elect a fairly safe and effective means of treating their weight problem: gastric banding. Reported in this week's Journal of the American Medical Association, Australian researchers used the laparoscopic technique in a group of teens whose body mass index exceeded 35. That's not just obese, it's very obese. When compared to teens with the same BMI who received diet and exercise interventions alone, the gastric banding group did much better in terms of overall weight loss and other measures, such as sleep apnea, diabetes or prediabetes.

Gastric banding involves restricting the size of the stomach with a banding device. The surgery itself is done laparascopically, with just a few small incisions. And the result is adjustable if needed down the road. This compares very favorably with gastric bypass, where substantial rerouting and organ removal is performed in a very significant surgery. Long term studies have demonstrated that while gastric bypass is usually very effective, it can result in malnutrition some time later.

A few of the teens who had gastric banding in this study required subsequent revisions, but there were no problems during the original surgery or in the first 30 days of follow-up. This illustrates a point Rick makes in the podcast: if you're considering gastric banding that old rule of surgery applies. Go to a center where both surgeon and staff could do these things in their sleep because they do them so frequently.

We conclude in the podcast, however, that it's an indictment of our society that we're having such a profound problem with teenage obesity. Data cited in this study indicate that over 5 million American teenagers today are obese, as defined by a BMI greater than 30. Obesity, of course, is not a condition that arises spontaneously overnight. Physicians and other health care professionals need to assess weight in children and teenagers regularly and intervene early to prevent excessive weight gain before it happens. And as a society we need to emphasize good health habits.

Another topic this week fits nicely: preventing childhood obesity in this issue of Pediatrics. It's so simple and requires assuring that children get 10 hours of sleep a night, eat most dinners at home with the family, and reduce TV watching. Other topics this week include the utility of MRI in planning breast cancer surgery from the Lancet, and the interference of one common antidepressant medication with tamoxifen for preventing breast cancer recurrence in the British Medical Journal. Give us a listen! Until next week, y'all live well.

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