The Preventative Health Journal - Australia & New Zealand

Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents: A Randomised Trial, conducted by researchers at the Centre for Obesity Research and Education (CORE), Monash University and the Centre for Adolescent Health at the Royal Children’s Hospital, Melbourne, compared the outcomes of gastric banding surgery with those of an optimal lifestyle program in 50 teens (14 to 18 years), over two years.1 

According to Professor Paul O’Brien, Head of CORE and lead author, the study reveals that adolescents can achieve important improvements in weight, health and quality of life following placement of a gastric band and with support from parents and healthcare professionals.1 

“Severe obesity in adolescents is associated with multiple serious diseases, impaired quality of life and reduced life expectancy,” said Prof O’Brien. 

 “While this study confirms that some adolescents can achieve substantial weight loss and health improvements through diet and exercise, gastric banding should be considered for those severely obese adolescents who find primary weight loss methods unsuccessful.”1 

The National Health and Medical Research Council (NHMRC) trial randomly allocated 25 adolescent participants with extreme obesity to a supervised lifestyle program, which included individualised diet plans, increased activity, a structured exercise schedule and behavioural modification.1 The other 25 adolescent participants underwent gastric banding surgery and were required to eat no more than three small, protein-containing meals per day, undertake at least 30 minutes of daily exercise and maintain a high level of activity.1 Both study groups were followed by experienced medical staff for two years.1  

At study completion, participants who underwent gastric banding had lost an average of 79 per cent of their excess weight, while those who adhered to the lifestyle program achieved a loss of 13 per cent.1 

Associate Professor John Dixon, Head of the Obesity Research Unit, School of Primary Health Care, Monash University and research co-author said there were important differences in outcomes between the two study groups. 

“The adolescents who were randomised to the surgical arm of this study achieved far more substantial weight loss than those who relied on lifestyle changes alone.1 

“The gastric banding group lost an average of 35kg per person, or more than one-quarter of their original body weight.1 

Meanwhile, the lifestyle program participants lost an average 3kg per person – just three per cent of their total original weight,” said A/Prof Dixon.1 

“In fact, six participants in the lifestyle group, who withdrew from the trial before its completion, had gained weight despite having access to a personal trainer, regular review by a physician, dietician and sports medicine physician, and regular medical education and guidance.”1 

In addition to achieving substantial weight loss, adolescents who underwent gastric banding experienced greater health improvements than those in the lifestyle group.1 At entry into the study, 36 per cent of gastric band participants and 40 per cent of lifestyle participants had an elevated risk of developing type 2 diabetes and heart disease, further illness and premature death.1 After two years however, none of the 24 gastric band participants who completed the study had the metabolic syndrome*, while the metabolic syndrome remained in four of the 18 people who completed the lifestyle program (22%).1 

The gastric banding group also experienced a greater improvement in insulin sensitivity than the lifestyle group.1         

More than half of the participants had increased resistance to insulin at entry to the study, but all of the gastric banding group were back to within normal level at two years.1   

“Overall, the gastric band group showed improvements in physical functioning, general health, self esteem, family activities and change in health; there was no change in the group’s general behaviour, mental health or family cohesion,”1 said A/Prof Dixon.

The study results were achieved within the context of very careful patient assessment, monitoring and support, and with an expert surgical and medical team.                  

Professor Susan Sawyer, Director, Centre for Adolescent Health, Royal Children’s Hospital and study co-author, says the results of this study will challenge those who feel uncomfortable about bariatric surgery for severely obese adolescents.  

“Severely obese adolescents are as deserving as adults about having access to clinical treatments that work. While this procedure is not for every severely obese adolescent, given the short and long-term consequences of obesity, these results are the strongest evidence yet that support adolescents with extreme obesity having access to comprehensive obesity services, including gastric banding.  

“Until we can find more successful behavioural and medical approaches to treating those with severe obesity, the results of this study unequivocally support considering gastric banding for those in whom medical approaches have been unsuccessful,” said Professor Sawyer.   

“A challenge for government is the need to invest more in clinical services for adolescents with severe obesity.”  

The study authors emphasise that this is not a “quick fix” but a serious approach to a serious problem. Careful assessment and counselling prior to the band is required, together with regular assessment by trained health professionals for the life of the band in order to achieve optimal effectiveness. While the gastric band facilitates correct eating, should patients eat too quickly or too large a volume, revision of the gastric band’s position may be required. This occurred in six of the trial participant during the two year study period.1 

The research demonstrates that gastric banding can improve current and future health in severely obese teens by reducing risk factors for type 2 diabetes and heart disease.1 

About LAGB surgery 

The laparoscopic adjustable gastric band (LAGB) is a buckle-design band placed laparoscopically (keyhole surgery) around the stomach that compresses the top of the stomach and reduces appetite.2 The band has a soft lining that can be inflated by injecting saline into an access port, just beneath the skin in the side of the abdomen, allowing for tightening of the band for further control over appetite, without surgery.2 

LAGB surgery does not require cutting or stapling of the stomach and there is no bypassing of parts of the digestive system. 

Most patients can return home the same day their band is placed.2 

LAGB surgery is suitable for severely obese adults, or obese adults with weight-related health complications, who have unsuccessfully tried other weight loss methods, such as diet and exercise.2 

Complications associated with gastric banding surgery include risks from the medications and methods used in the surgical procedure, the risks associated with any surgical procedure, and the patient’s degree of intolerance to any foreign object implanted in the body.2 

About obesity 

Obesity is the accumulation of excess fat in the body due primarily to energy imbalance, whereby energy intake from diet is greater than energy output through physical activity.4 Obesity can also be linked to genetic, perinatal and socioeconomic factors.3 

Weight status is often measured using the body mass index (BMI); measured by body weight (in kilograms) divided by height (in metres squared). A BMI of 25–30 is considered overweight, while a BMI greater than 30 is obese.3 

People who are obese are at higher risk of premature death and many health complications including type 2 diabetes, heart disease, osteoarthritis and some cancers.3  

More than 3 million adult Australians are obese, costing the community more than $21 billion each year.3