AURORA, Colo. Oct. 1, 2018 - Adolescents with severe obesity achieve substantial and lasting weight loss with both the sleeve gastrectomy and gastric bypass procedures--but not with gastric banding--according to a team of researchers across the United States. The study is the largest to date to focus on adolescents having bariatric surgery. It was able to include 544 teens, twice as many as the largest previous study, thanks in part to its use of a new, large resource called PCORnet®, the National Patient-Centered Clinical Research Network.
While short- and long-term studies (1- to 8-year outcomes) of Roux-en-Y gastric bypass had shown significant and sustained weight loss in adolescents, fewer studies of sleeve gastrectomy and adjustable gastric banding had been done in adolescents, leaving many questions to be answered. This study was conducted to address this knowledge gap.
Major findings of the PCORnet Bariatric Study included:
- From 2005 to 2015, sleeve gastrectomy became the dominant procedure used in adolescents, while use of gastric bypass and adjustable gastric banding markedly declined.
- Gastric bypass and sleeve gastrectomy resulted in comparable weight loss through at least three years follow-up.
- Adjustable gastric banding was much less effective than the two other operations.
- Very few surgical and medical complications occurred within 30 days after surgery.
The results are the first to be produced using the resources of PCORnet®, which is funded by the Patient-Centered Outcomes Research Institute (PCORI) and designed to produce clinical insights faster and less expensively than traditional clinical studies. It involves multiple individual networks that together represent more than 100 million patients. The network securely collects health information during routine care, minus data that could help identify individuals, to produce real-world evidence with outcomes that matter to patients, who are full partners in this research.
The September issue of Surgery for Obesity and Related Diseases (SOARD) published these results. The article is titled "Comparative Effectiveness for Bariatric Procedures Among Adolescents: The PCORnet Bariatric Study."
This research matters because severe obesity now affects 4-6 million U.S. adolescents and is linked to many health conditions including sleep apnea, high blood pressure, and other heart risks. Many people tend to gain weight as they age, so severe obesity in children and adolescents is concerning. And it is also linked to developing type 2 (once called adult-onset) diabetes before adulthood.
"There is a dire need to identify effective strategies to combat the myriad health problems associated with pediatric obesity," says Thomas H. Inge, M.D., Ph.D., the article's first author and chief of Pediatric Surgery and director of the Bariatric Surgery Center at Children's Hospital Colorado.
Medication options are limited for adolescents with severe obesity. So bariatric surgery is the only option offering the prospect of durable, long-term weight loss for adolescents who have been unable to lose significant weight with traditional weight loss measures, including diet and exercise.
"The results we found in adolescents are remarkably similar to what we have seen in adults who get these three most commonly used bariatric surgery procedures," says David Arterburn, M.D., M.P.H., another study leader, who is a senior investigator at Kaiser Permanente Washington Health Research Institute in Seattle. The other leaders of the study are Kathleen Mary McTigue, M.D., M.P.H., M.S., an associate professor of Medicine and Epidemiology at the University of Pittsburgh; and the Rev. Neely Williams, M.Div., a patient-principal investigator at the Community Partners' Network in Nashville.
"We are encouraged to see that less risky and more recently introduced operations like laparoscopic sleeve gastrectomy can achieve similar results to the more complex procedures like gastric bypass," Dr. Inge adds.
For the study, PCORnet® gathered and analyzed data from electronic health records of 11 Clinical Data Research Networks representing 27 participating health care systems nationwide. Adolescents age 12-19 years were identified who had a first bariatric procedure from 2005 through 2015. The percentage change in body mass index (BMI) was calculated at 1, 3, and 5 years. The researchers used BMI, a measure of weight for height, rather than weight, because many of the adolescents were still growing taller. Before bariatric surgery, the adolescents had severe obesity, with a mean BMI of nearly 50 kg/m2.
Overall, these findings provide strong evidence of effectiveness and safety of surgery for severely obese adolescents who have extremely limited options for achieving weight loss. This research adds substantially to the information available to families and doctors who struggle with decision-making for adolescents with weight-related health complications. Additional long-term studies are needed to address nutritional concerns and changes in other health conditions such as diabetes.
This PCORnet® study, registered at ClinicalTrials.gov (NCT02741674), was funded by PCORI through PCORI Award OBS-1505-30683.
About Children's Hospital Colorado
Children's Hospital Colorado is a leading pediatric network 100 percent dedicated to the health and well-being of children, adolescents and young adults. Consistently acknowledged as one of the nation's top pediatric hospitals by U.S. News & World Report, Children's Colorado is recognized nationally and internationally for its medical, research, education and advocacy programs. It is at the forefront of research in childhood disease and pioneering treatments that are shaping the future of pediatrics, as well as offering everyday care for kids throughout Colorado and surrounding states. Founded in 1908, Children's Colorado offers a full spectrum of family-centered care at its urgent, emergency and specialty care locations throughout Metro Denver and Southern Colorado, including its location on the Anschutz Medical Campus. Scheduled to open in early 2019, the new Children's Hospital Colorado, Colorado Springs will be the first pediatric-only hospital in southern Colorado. For more information, visit http://www.childrenscolorado.org, or connect with us on Facebook and Twitter.
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Surgery for Obesity and Related Diseases