Wednesday, February 22, 2012

Is Bariatric Surgery an Appropriate Treatment for Adolescent Obesity?

Bariatric surgery is being employed more and more today to fight obesity in adults. And it is being suggested that the surgery is appropriate for children. In general, to be a candidate for bariatric or weight-loss surgery, using the National Institutes of Health (NIH) guidelines, an adult must have a BMI greater than 40 or a BMI greater than 35, with weight related comorbidities. Last year, the FDA lowered the BMI guidelines for lap band surgery to 30 for those with weight related comorbidities. Now, some experts believe that it may be appropriate to consider laparoscopic adjustable gastric banding for adolescents.

As one study indicated: “Morbidly obese adolescents often fail to lose weight with diet and exercise and, as adults, become candidates for surgical intervention." And the researchers continued: "The presence of more serious co-morbidities in obese adults, coupled with the successful weight loss after laparoscopic adjustable gastric banding, in adolescents suggests that weight loss surgery might be indicated at a younger age for severely obese individuals.”

It should be emphasized, however, that before opting for bariatric surgery, weight loss providers and their patients should engage in an intense diet, exercise and counseling program. However, when non-surgical methods fail, being able to use bariatric surgery might not be out of the question. One of the forms of bariatric surgery being proposed for adolescents by some experts is lap band surgery. It should be noted, however, that lap band surgery has it drawbacks.
One of the drawbacks of bariatric surgery for children might be an interference with a child's growth. And overall, the surgery may not be as effective as once thought. In fact in Europe, lap band surgery is being chosen less often for weight loss. Still, more research will help determine if the surgery might be a good option for obese adolescents. At any rate, bariatric surgeons and physicians who specialize in nonsurgical medical weight loss (bariatricians, for example) should work with their patients to arrive at the most appropriate weight loss treatment.

Even if lap band surgery is not as applicable or effective as we would like for it to be, the surgery could nevertheless have a place in the fight against obesity in adolescents. Indeed, getting a handle on any segment of childhood obesity will require using every option available.

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Wednesday, February 8, 2012

Bariatric Surgery May Lead to Improved Obesity Fighting Treatments

Obesity is a serious worldwide problem. Obesity increases the incidence of illness and puts pressure on a health care budget. For these and other reasons, many experts around the world are looking for ways to solve the obesity problem. Since bariatric surgery continues to be the most effective approach to weight loss, researchers are trying to determine exactly how bariatric surgery allows a person to lose weight. Experts will then use the research results to develop better ways to fight obesity.

Some understanding of gastric bypass surgery has already led to the construction of EBTs or endoscopic bariatric therapies. As a recent white paper on EBTs reported, EBTs are "performed entirely through the gastrointestinal (GI) tract using flexible endoscopes..." And "[u]sually there is no surgical incision associated with EBTs. Many EBTs mimic the functions of bariatric surgery.” Most of these EBTs are medical devices that are inserted into the body via some existing body orifice.
Further, knowledge gained from bariatric surgery may provide us with improved weight loss pharmacotherapy. A deeper understanding of gastric bypass surgery and laparoscopic sleeve gastrectomy may lead to more effective weight loss drugs. One naturally occurring hormone in the body that has received a lot of attention during the last few years is ghrelin. Ghrelin is believed to play a role in lessening the desire to eat more food.

And research has shown that laparoscopic bypass surgery and laparoscopic sleeve gastrectomy reduce the amount of ghrelin in the body, post surgery. This finding lends support to the idea that a drug can be produced that will lessen the effects of ghrelin, therefore, reducing the desire to eat. This, in turn, could lead to weight loss.

In fact, in 2006, the Scripps Research Institute developed a vaccine that targeted ghrelin in animals. And the "anti-obesity vaccine ... significantly slowed weight gain and reduced body fat in animal models."

As bariatric surgery results are studied and understood, medical weight loss options might be enhanced. Both patients and weight loss service providers could benefit. Medical and surgical weight loss service providers should monitor the progress made in bariatric surgery research. The providers will then know when they might offer improved weight loss and weight management services based on the bariatric surgery research results.

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