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Bariatric surgery in teens shows promise in study

| Monday, Nov. 9, 2015, 9:14 p.m.

Bariatric surgery reduced type 2 diabetes and lowered blood pressure in high percentages of teens in a recent study, suggesting the weight-loss procedure may be more effective when performed earlier in life than is common now, said one of the study's authors.

The results, published Friday in the New England Journal of Medicine, could help fight a public health condition that affects more than a third of U.S. adults, said Dr. Anita Courcoulas, chief of minimally invasive bariatric and general surgery for UPMC, and one of the study's lead investigators.

“Childhood obesity is certainly driving the adult obesity epidemic,” Courcoulas said.

The study in Pittsburgh and at four other sites across the nation tracked 242 adolescents, ages 13 to 19 and weighing an average 328 pounds, for three years after the weight-loss procedure. Participants lost an average 27 percent of their body weight, which is about how much adults lose after the procedure, Courcoulas said.

But among 20 participants who had type 2 diabetes at the start, 19 were in remission at the end, according to study results. While the result is limited to a small group, the 95 percent remission rate is higher than the 60 percent remission rate observed in adults at three years, Courcoulas said.

In a group of 96 adolescents who started with high blood pressure, 74 percent had normal blood pressure at the end, according to the study. In adults, 40 percent to 50 percent return to normal blood pressure, Courcoulas said. The procedure improved kidney function and eliminated pre-diabetes and high cholesterol in some of the adolescents, according to the study.

The surgery also caused negative side effects. More than half of the participants had trouble absorbing iron at the end of the study, and some had vitamin A and vitamin B12 deficiencies. About 13 percent had to undergo one or more additional surgeries.

Study participants underwent two types of bariatric surgery, known as gastric bypass and sleeve gastrectomy. Both shrink the stomach so fewer calories are absorbed and appetite is decreased. The sleeve removes 80 percent of the stomach from the body, while the bypass connects a small portion of the stomach to the small intestine and leaves the rest in the body to continue to produce acids and digestive enzymes.

Smaller studies have shown the surgery's value for teens, but many insurers don't cover it until people are 18 years old, said Dr. George Eid, assistant director of Allegheny Health Network's Bariatric and Metabolic Institute. Eid said he was involved with the study at UPMC before moving to AHN.

Benefit details on insurers' websites say the surgery may be covered before 18 in limited circumstances, such as when teens' bones have stopped growing.

Once people are overweight by as much as 80 or 100 pounds, diet and exercise become ineffective as ways to lose weight and keep it off, Courcoulas said. Bariatric surgery is reserved for severely obese patients whose risk of other health problems is much higher, she said.

The study will continue to follow the participants — about a fifth of whom are in the Pittsburgh area — and will produce 5-, 7- and 10-year results, Courcoulas said.

Riley Reffner, 18, of Rochester, a freshman at Slippery Rock University, said she has lost 75 pounds since she underwent a gastric bypass in April, and she expects her weight to keep dropping. Signs of prediabetes have decreased, and symptoms of polycystic ovary syndrome have gone away, she said. Reffner was not part of the study, which was funded by the National Institutes of Health.

Reffner said many of her family members are obese, and she had tried diet and exercise programs starting at 8 years old without success.

The gastric bypass weight loss has allowed her to enjoy many of the things that most people take for granted, such as walking without losing her breath and not having to worry about sitting at a desk or being able to clip a seatbelt on an amusement park ride.

Reffner said she received the surgery shortly after turning 18, when her insurance covered it.

“I wanted to do it earlier in my life so I could keep it in control throughout my life,” Reffner said.

Wes Venteicher is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or wventeicher@tribweb.com.

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