A higher percentage of severely obese adolescents who received laparoscopic adjustable gastric banding lost more than 50 per cent of excess weight and experienced greater benefits to health and quality of life compared to those in an intensive lifestyle management programme, according to a new study from Australia.
In the study, doctors examined whether gastric banding would induce more weight loss and would provide greater health benefits and better improvement in the quality of life of severely obese adolescents than the application of currently available lifestyle approaches.
The randomised controlled trial included 50 adolescents between 14 and 18 years of age with a body mass index (BMI) higher than 35 who were assigned either to participate in a supervised lifestyle intervention or to undergo gastric banding, and followed up for two years. The lifestyle intervention programme included reduced calorie intake, increased activity and behavioural modification.
The study was performed between May 2005 and September 2008. Twenty-four of 25 patients in the gastric banding group and 18 of 25 in the lifestyle group completed the study.
The researchers found that the primary outcome of greater than 50 per cent of excess weight loss was achieved by 21 of 25 participants (84 per cent) in the gastric banding group and three of 25 (12 per cent) in the lifestyle group. At two years, the gastric banding group had lost an average of about 76lbs, representing an overall average loss of 28.3 per cent of total body weight and 78.8 per cent excess weight loss.
The lifestyle group lost an average of 6.6lbs, representing an average 3.1 per cent total weight loss and 13.2 per cent excess weight loss. The differences between groups were significant for all weight measures at 24 months.
“At entry, nine participants (36 per cent) in the gastric banding group and 10 (40 per cent) in the lifestyle group had the metabolic syndrome.
At 24 months, none of the gastric banding group had the metabolic syndrome compared with four of the 18 completers (22 per cent) in the lifestyle group,” the doctors reported. The gastric banding group experienced improved quality of life with no adverse events in the period shortly after surgery. However, eight operations (33 per cent) involving revisional procedures were required in seven patients in the surgery group.
“In this study, gastric banding proved to be an effective intervention leading to a substantial and durable reduction in obesity and to better health,” the doctors commented. “The adolescent and parents must understand the importance of careful adherence to recommended eating behaviours and of seeking early consultation if symptoms of reflux, heartburn, or vomiting occur.
“As importantly, they should be in a setting in which they can maintain contact with health professionals who understand the process of care.
“This study indicates that, in such a setting, the laparoscopic adjustable gastric banding process can achieve important improvements in weight, health and quality of life in severely obese adolescents,” said the authors.
JAMA 2010;303:519-526
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