Teen Bariatric Surgery – Successes and an Unrelated Failure

La plus grosse femmeThe Teen-Longitudinal Assessment of Bariatric Surgery, which is known as Teen-LABS for short, aims to document “the efficacy and complications of bariatric surgery in the adolescent surgical patient and its role in the overall management of obesity prior to and through the emerging years of adulthood.” The literature says,

The goal of Teen-LABS is to facilitate coordinated clinical, epidemiological and behavioral research in the field of adolescent bariatric surgery, through the cooperative development of common clinical protocols and a bariatric surgery database that will collect information from participating clinical centers performing bariatric surgery on teenagers.

In addition to investigating surgical outcomes, another broader goal of Teen-LABS is to better understand the etiology, pathophysiology and behavioral aspects of severe obesity in youth and how this condition affects human beings over time.

The basic question is whether adolescence is the optimal window for surgical intervention, and in order to answer it, a very large number of patients need to be followed up over an extended period of time.

One problem with the popular meta-study format is that the various sources of data are not grounded with comparable roots. Just to make up an example, from the combination of a 2010 study of European children ages 12-15, a 2012 study of Hispanic children ages 10-15, and a 2013 study of an ethnically mixed children ages 9-14, it is difficult to draw meaningful and useful conclusions.

The methodology behind Teen-LABS is to use standardized definitions and clinical protocols, measured by the same data-collection instruments. The same tools are used to evaluate, select and follow the patients, eliminating the confusing differences the arise from attempts to cobble together the results of many independent studies.

The extent

Founded in 2006, the Teen-LABS effort involves 5 major medical centers. There are 8 primary investigators, including chairperson Dr. Thomas Inge MD, PhD, (surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center) and 8 other team members who coordinate the research data. The guidelines for abstracts, presentations and publications are strictly controlled. During 2015, 3 Teen-LABS publications appeared, along with 4 ancillary publications.

Meanwhile, other related work goes on. Dr. Inge was principal investigator and lead author of a study whose results were published in the New England Journal of Medicine. The subjects were 242 adolescents (13-19) who were all 3 years past their bariatric surgery. 325 pounds was the average weight of the patients before surgery. Because Caucasian females are the main group seeking surgery at the participating medical centers, they made up most of the subjects in this particular case. Dr. Inge wrote,

At three years, almost 90 percent experienced clinically meaningful weight loss, and participants were in better health, with improved quality of life scores.

Also true after 3 years: the average weight loss was 27%, or around 90 pounds. More importantly, 95% of the participants experienced reversal of type 2 diabetes, and 86% showed normalized kidney function. In 74%, high blood pressure disappeared, and there was reversal of lipid abnormalities in 66%.

A short case history

Not all kids fare so well, and this story is for the purpose of contrast. In 2012, young Shani Gofman allowed New York Times reporter Anemona Hartocollis to shadow her for her first post-op year.  The history was that Gofman had been fat-shamed at school starting in 4th grade. When she was 17, her pediatrician brought up the idea of surgery, but the girl resisted, announcing her intention to diet. Instead, she gained 30 pounds over the next 8 months. When surgery was decided upon, she was supposed to prepare by limiting herself to a liquid diet, but splurged instead, reasoning that soon enough, she would be unable to.

On her 19th birthday, Gofman weighed 271 pounds with a body mass index, which quite exceeded the recommended BMI. A state insurance plan for low-income families covered the more than $20,000 cost of lap-band surgery, Hartocollis meticulously documented the various circumstances and tribulation of Gofman’s life that led to her backsliding. Just after her 20th birthday, she had gained back almost half of the weight lost in the first halcyon months. A mere year later, she was back for additional surgery to tighten the band, “so it now took an hour and a half to force down two scrambled eggs.”

The journalist points out that health plans of every kind are often more willing to pay for a surgical procedure than for more conservative treatment plans, and also that…

…the long-term effectiveness of weight-loss surgery, particularly stomach banding, the procedure Ms. Gofman had, is still in question.

Your responses and feedback are welcome!

Source: “Adolescent Bariatrics: Assessing Health Benefits and Risks,” Undated
Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Image by Stefan


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