Before looking at some topics connected with bariatric surgery for minors, the illustration on this page announces tomorrow’s event in Oman, a lovely city located on the Persian Gulf. Dr. Pretlow will be speaking about exciting new ideas, and participating in a panel, at the World Obesity Federation Regional Conference.
This is an opportune time to note that Dr. Pretlow’s many public appearances over the years are conveniently organized and described on another Childhood Obesity News page.
Five years ago, it was apparent to the medical world that bariatric surgery could produce impressive outcomes. Patients’ cardiovascular situations improved, especially in the reduction of strokes and myocardial infarctions. With surgery, plus intensive medical therapy, patients with uncontrolled type 2 diabetes achieved much better glycemic control than those with just the intensive medical therapy.
Weight loss is considered in different ways. Statistics showed that patients with gastric bypass surgery lost a larger percentage of their baseline weight than did those with sleeve-gastrectomy. Concerning the Roux-en-Y (RYGB) gastric bypass, a 16-year post-op followup study showed that “patients mean weight loss was 55% of excess body weight,” which is different from measuring relative to baseline weight.
Many patients previously afflicted by such conditions as type 2 diabetes, hypertension, asthma, stress incontinence, and sleep apnea found relief. Morgan Downey of the Downey Obesity Report wrote,
How bariatric surgery resolves type 2 diabetes in over 80% of patients still remains to be determined. It has been observed that bariatric surgery blunts adaptive thermogenesis which takes place with other weight loss interventions, resulting in greater, more durable weight loss. Changes in gut hormones may also play a key role… Researchers believe that it is bile acids in the blood, not the reduction in size of the stomach that produce the weight loss effects.
An interesting thing about RYGB surgery is that the patient experiences changes in taste, smell, and appetite. An amazing three-quarters of the post-op patients “developed aversions to specific foods with meat, sweets, dairy and junk/fried foods leading the aversion list.” At the same time, there was great anticipation for the development of drugs that could accomplish the same results as bariatric surgery, without the surgery.
A 2018 study of “Teen Longitudinal Assessment of Bariatric Surgery” (also known as “Teen-LABS”) looked at data from 242 subjects. 161 of them had the Roux-en-Y procedure. Sixty-seven had vertical sleeve gastrectomy, and 14 had undergone adjustable gastric banding. Three years after surgery, only 5% still had three or more risk factors.
By that time, in the United States, children as young as seven had experienced weight-loss surgery. The Kids’ Inpatient Database held records on 78,649 obese children, of whom 1,600 or about 2% have had bariatric surgery. According to the database, the average age was slightly more than 18 years, but there were also participants as young as seven years old. In any age group, it became more and more obvious that adequate after-care is crucial.
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Source: “Keeping Up with Bariatric Surgery,” DowneyObesityReport.com, 05/12/14
Source: “Should Children Have Weight Loss Surgery?,” Healthline.com, 01/09/18
Image by World Obesity Federation Regional Conference