A type of weight-loss surgery not approved for adolescents is becoming more and more common among teens in California, according to a report published today.
Most of the patients are white girls, although they make up less than half of overweight youth, researchers say.
From 2005 to 2007, they found rates of so-called gastric banding, in which a silicone band is placed around the top portion of the stomach to restrict food intake, rose five-fold. However, use of gastric bypass - which surgically reduces the size of the stomach - dropped, leaving the overall rate of weight-loss procedures constant.
Despite not being approved by the Food and Drug Administration for use in adolescents younger than age 18, gastric banding overtook gastric bypass as the most frequently performed weight-loss procedure in this age group, Dr. Daniel DeUgarte and colleagues from the University of California, Los Angeles, report in the journal Pediatrics.
This increase in the use of gastric banding, they note, occurred during a time at which there was a significant increase in the intensity of marketing and propensity to use the procedure in morbidly obese adults.
They add that gastric bypass remains the "gold standard" of weight-loss surgery, and that some medical centers have found poor long-term results with gastric banding.
Among the 590 California youths between 13 and 20 years of age who underwent weight-loss procedures over three years, no one died and the rate of in-hospital complications were comparable at less than six percent.
Gastric banding leapt from 0.3 per 100,000 youth to 1.5, whereas bypass surgery decreased from 3.8 per 100,000 to 2.7. Hospital stay was less than a day with the first procedure, and more than two with the second.
While white people account for just over a quarter of overweight adolescents in California, they made up about two-thirds of those who had surgery. There could be many reasons for these findings, according to the researchers, who note that only severely obese people who have failed diet and exercise programs are considered for weight-loss surgery.
"I do think that has something to do with the difference between male and female body image perception," said Dr. Marc P. Michalsky, surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Columbus, Ohio, who was not involved in the research.
But, he added, "We try very, very hard to dispel any notion that this is a cosmetic procedure."
Michalsky said he wasn't surprised by the new findings, but noted that solid evidence for gastric banding has yet to be produced.
"Why do we feel it is necessary to operate on a bunch of 15-year-olds?" he told Reuters Health. "The theory is, and we have yet to prove this, that early intervention will result in a substantial difference in the outcomes regarding obesity-related diseases," such as diabetes and heart disease.
While weight-loss surgery may cost up to $50,000, for some individuals, he said, it appears to be the only way to achieve durable results.
A British study last month showed that use of the procedures had increased 10-fold since 2000. At 30 months, those who had had gastric banding had lower death rates than those who had undergone bypass surgery.
Other experts remain skeptical of gastric banding, including Allergan's Lap-Band, which commands more than two-thirds of a $300 million to $400 million market.
"I think there's a fundamental problem with putting a rigid plastic object around a moving organ. You're asking it to stay in place and not erode over a long period of time," Dr. Mary Brandt, director of the pediatric surgical program at Texas Children's Hospital in Houston, told Reuters in July.
"I'll be happy to reverse my position as soon as I see 10 or 20 year data. Unfortunately, that's not something that industry is excited about funding," she said.