Gastric Band for Teenagers

Gastric Band for Teenagers

The worldwide epidemic of obesity has affected even the teenagers. The reasons could lie in their being ‘couch-potato’, consumption of fancy foods / fast food / processed food, lack of physical activity related to undue involvement with modern gadgets.

Separate guidelines for adolescent bariatric surgery exist. It is indicated in adolescents with BMI > 35 kg/m2 with serious obesity related diseases like type 2 diabetes or BMI > 40 kg/m2 with less serious obesity related diseases like hypertension, hyperlipidemia etc.

Procedure
The upper part of the stomach is converted to a pouch of 15 ml capacity by the encircling band. This acts as a restrictive procedure, restricting an increased intake of food. The narrow passage between the small pouch and the remaining stomach allows passage of food slowly. The band can be inflated or deflated to alter the calibre of this passage to control the intake of food. The rapid filling of the small pouch also results in early satiety. It is a least invasive bariatric invasive procedure which is completely reversible and hence any other bariatric procedures may be performed at a later date.

Advantages

The reduction of weight is significant. In a scientific study, it was found that the excess weight loss after “Gastric Band” was more than 75% in comparison to 13% with lifestyle changes only. With proper nutritional guidance, stunting of growth can be prevented.

Ethical and other issues

Obesity surgery in teenagers is controversial because of ethical issues of consent for surgery which is a life-changing procedure. There are also issues about the understanding of the procedure by the teenager and immediate risks of surgery.
The young patients are more likely expected to lose weight with dieting and exercise. A weight loss surgery in these patients should be done with proper indication. The surgery should not convey the message to teenagers that it is OK to eat anything as it can be corrected with surgery whenever desired. The lap-band is still not approved for use in adolescents by FDA.

Gastric Band for Teenagers

The worldwide epidemic of obesity has affected even the teenagers. The reasons could lie in their being ‘couch-potato’, consumption of fancy foods / fast food / processed food, lack of physical activity related to undue involvement with modern gadgets.

Separate guidelines for adolescent bariatric surgery exist. It is indicated in adolescents with BMI > 35 kg/m2 with serious obesity related diseases like type 2 diabetes or BMI > 40 kg/m2 with less serious obesity related diseases like hypertension, hyperlipidemia etc.

Procedure
The upper part of the stomach is converted to a pouch of 15 ml capacity by the encircling band. This acts as a restrictive procedure, restricting an increased intake of food. The narrow passage between the small pouch and the remaining stomach allows passage of food slowly. The band can be inflated or deflated to alter the calibre of this passage to control the intake of food. The rapid filling of the small pouch also results in early satiety. It is a least invasive bariatric invasive procedure which is completely reversible and hence any other bariatric procedures may be performed at a later date.

Advantages

The reduction of weight is significant. In a scientific study, it was found that the excess weight loss after “Gastric Band” was more than 75% in comparison to 13% with lifestyle changes only. With proper nutritional guidance, stunting of growth can be prevented.

Ethical and other issues

Obesity surgery in teenagers is controversial because of ethical issues of consent for surgery which is a life-changing procedure. There are also issues about the understanding of the procedure by the teenager and immediate risks of surgery.
The young patients are more likely expected to lose weight with dieting and exercise. A weight loss surgery in these patients should be done with proper indication. The surgery should not convey the message to teenagers that it is OK to eat anything as it can be corrected with surgery whenever desired. The lap-band is still not approved for use in adolescents by FDA.

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Weight Loss Surgery and Heart diseases

Obesity has most pronounced effects on the cardiovascular system. weight loss surgery is ideal in the control or resolution of many diseases of heart and blood vessels.
Hypertension is one of the commonest diseases associated with obesity and up to 70% of the patients undergoing weight loss (bariatric) surgery have hypertension. It occurs due to increased tone of blood vessels, retention of sodium and water resulting from hormonal changes and insulin resistance. The obesity surgery has been found to reduce the requirement of antihypertensive drugs in 18-36% cases and improves or resolves it completely in up to 50% patients.
Hyperlipidaemia is present in half of obese patients and is a risk factor for atherosclerosis and coronary disease. The triglycerides and total cholesterol reduce and there is an increase in HDL cholesterol after obesity surgery. These changes are maximal after Roux-en-Y gastric bypass.

Congestive heart failure may occur in obese patients due to high cardiac output and circulating volume of blood. After obesity surgery, the cardiac performance improves and is demonstrable by a reduction in the thickness of left ventricle of heart. The ejection fraction of left ventricle (fraction of blood ejected during contraction of left ventricle) also improves.
Coronary artery disease is more common in patients with morbid obesity. After the weight loss surgery, the blood flow in the coronary arteries improves as demonstrated by transthoracic Doppler echocardiography. The risk of coronary artery disease is reduced by 39% in men and 25% in women after weight loss surgery induced resolution of hypertension.

Atherosclerosis in obese people is related to insulin resistance, hyperlipidaemia, diabetes and hypertension. Obesity surgery has been proven to decrease or reverse fatty plaque deposition in the blood vessels. In a scientific study it was found that 18 months after obesity surgery, the thickness of blood vessels reduced and flow mediated dilatation improved. All these factors result in improved long term survival.