Overweight teenagers in America are now undergoing laparoscopic gastric band surgery, a weight-loss procedure that isn’t even approved for anyone under 18 years old. But one California study last year found that gastric band operations for patients as young as 13 had increased seven-fold over the previous five years.

In gastric band surgery, an inflatable silicon ring is placed around the upper portion of the stomach. This creates a smaller stomach, which makes people feel full sooner and reduces the amount they eat. And there’s big money in those little rings. Allergan, the company that manufactures the Lap-Band® device, has estimated that sales of its obesity intervention products will top $240 million in 2011. 

Eighteen percent of the patients in this study were under 18, and almost 80 percent were female. And while whites make up only 28 percent of overweight adolescents in California, they accounted for 65 percent of the weight-reduction operations.

The study’s co-author Dr. Daniel DeUgart himself insists that diet and exercise (the usual ways to lose weight) are “proven again and again to be ineffective at getting morbidly obese patients to lose weight”.  Some experts like DeUgart, a pediatric surgeon at the University of California, Los Angeles, believe these surgeries are needed; but others have expressed concern that teens may be risking their health looking for a quick fix.

For example, Dr. Edward Livingston, himself a gastric surgeon at the University of Texas Southwestern School of Medicine, is concerned about both the popularity of weight-loss surgeries and some of the surgeons who do them. He explains:

“These operations clearly help some people, but they’re trying to sell it as a solution for everybody. If you follow the rules, it works. But most people who get to be 400 pounds aren’t very good at following rules.”

And 93 per cent of the weight-reduction surgeries studied were performed in hospitals that are not affiliated with nationally recognized children’s hospitals despite the fact that the youngest patients were only 13 years of age, the study authors reported.

As investigative health journalist William Heisel wrote in his piece called Irresponsible Marketing for Lap-Bands May Have Deadly Consequences, published on Reporting On Health:

“The consequences can be severe when gastric band clinics lure patients by setting up  1-800 numbers and offering free seminars seven days a week to extol the virtues of Lap-Band® surgery, all while telling patients that “Dieting sucks” or “Diets fail.”

Even the California study authors admitted that although “manufacturers have touted the banding procedure as less invasive, many [medical] centers have abandoned gastric banding because of poor long-term results” amid concerns about chronic esophageal blockage, the need for frequent readjustments, and complications from the surgery.

Then there’s cost: up to $17,000 for the average gastric band procedure, according to experts. Most of the families of the young patients in the recent California study paid that amount in cash, out-of-pocket.

Proponents argue that obesity carries its own health risks. Morbid obesity is a major problem for today’s youth, DeUgart insists:

“Surgery is increasingly becoming a treatment option for obese adolescents, and in the right setting and with proper evaluation, it may be appropriate.”

But surgery isn’t a cure-all for obesity. And the study doesn’t say if the procedures kept weight off in the long term.

In a compelling Junkfood Science article by Sandy Szwarc, she cited research suggesting that weight loss rebounds within 5 years in almost all weight loss interventions, essentially making any gastric surgery study follow-up that’s shorter than five years insufficient to demonstrate any lasting effectiveness. She also lamented the reality that bariatric surgeries are becoming more common among North American children.  Her article cited surgeons who described gastric lap bands for children as holding “promise” based on a previious study at New York University Medical Center.

Not everybody, however, would describe this trend as “promising”. Joanne Ikeda, a nutritionist emeritus at the University of California, Berkeley, believes:

“I don’t think altering the human digestive tract is a solution to the problem of excess weight. Doctors know little about the long-term effects of such operations on children.”

But one of the true ironies of all bariatric surgery is that basically it’s diseasing the stomach, according to the University of Chicago’s Dr. Eric Oliver, author of Fat Politics, who explains:

“This surgery takes a healthy organ and inhibits its proper functioning, meeting the authoritative Stedham Medical Dictionary definition of a disease.”

But conditions primarily seen in starvation-ridden countries and serious or terminal illnesses are now being reported among bariatric patients, from crippling osteoporis, immunological problems, iron deficiency anemia, malnutrition, developmental delays to brain damage.

For example, in 2004, Cincinnati Children’s Hospital Medical Center began reporting cases of beriberi in teenagers after bariatric surgery, according to the Journal of Pediatrics. Beriberi is caused by thiamine deficiency typically seen in starvation and severe alcoholism. It can result in memory loss and dementia, growth retardation and learning difficulties, congestive heart failure, neurological damage that’s usually irreversible, and death.

Dr. Oliver also predicted that bariatric surgery will be performed on younger people with lower and lower body mass indexes (BMI), adding:

“That will further pathologize weight at lower and lower levels.”

In fact, it’s already happened. This week’s announcement by the FDA is great news for Allergan, who coincidentally produce Botox® as well. Gastric banding surgery has now been approved for people with a BMI between 30 and 40, which accounts for almost 40 million North Americans. This news will significantly increase the pool of residents eligible for this surgery. Previously, the Lap-Band® was only approved by the FDA for those with a BMI of 40 and over, or those with a BMI of 35 with at least one other serious obesity-related condition (such as heart disease, uncontrolled blood pressure or diabetes).

Consumer Reports Health reminds us that Allergan has video testimonials on its website from people who say they’ve had the surgery and tout its benefits. The company even  held a contest to give away a free surgery to three “lucky” winners.

Gastric band surgeons advertise the surgery as if it were a luxury vacation:

“All inclusive! We’ll beat or meet any advertised price! Only $3,999!”

But before we jump onto the lapbandwagon, Consumer Reports Health investigators warn us to take a closer look at the troubling risks revealed in the fine print. Allergan’s own website reports a study that followed 299 people for three years after the  surgery, 25% of whom had a second operation to remove the band.  That’s a lot of dissatisfied customers, they say:

“Imagine if 25% of people who owned Toyotas were so dissatisfied that they called up their dealers and asked them to come and take their cars out of their driveways.

And 9% of those studied needed a second operation to fix problems with the band;  9% needed an additional procedure to fix a leaking or twisted access port, a design issue that the manufacturer says has been improved. Four people even had the band erode into their stomachs.

Another study in Australia found that one-third of operations on teenagers required follow-up surgeries within two years, often because of “pouch dilation” when the stomach above the band becomes enlarged, which can happen if the patient does not follow the regimen and tries to eat too much.

Less serious side effects are also common:

• Half the people who had the procedure reported nausea and vomiting.
• 34% suffered from gastro-esophageal reflux
• 24% experienced band slippage (which might stem from excessive vomiting)
• 14% developed stomach blockages

And last year, Allergan launched an unusual social media campaign for its Lap-Band®, urging American consumers to petition the U.S. Congress for legislation favouring weight-loss surgery options like the adjustable gastric band. First prize in its promotional contest was a trip to Washington, D.C. where the winner would present the petition to Congress.

The effort, according to a BNet report, was unusual for a pharmaceutical brand, organized as if it were a political campaign rather than an act of advertising:

“In addition to as-yet undefined legislation, Allergan also aims to change the culture around obesity, by redefining it as a ‘disease’ rather than a ‘choice.’ Allergan also urged consumers to highlight the petition effort on Facebook, Twitter and all other social media tools.”

Investigative reporter William Heisel adds that most overweight people are not in fact good candidates for gastric banding. This surgery  was approved by the FDA only for those with chronic and severe weight problems. Even Allergan recommends that suitable surgical candidates should have a body-mass index (BMI) of 40 or higher, or should be at least 100 pounds heavier than their ideal weight in order to qualify for gastric banding. For most overweight but not morbidly obese people, he warns, a surgical intervention (with real risks of complications and death) is not the answer.

Dr. Wendy Scinta is a family physician and a bariatrican herself who sits on the board of trustees for the American Society of Bariatric Physicians. She cautions that gastric band surgery in patients with a lower BMI carries unknown risks:

“It takes just 5 – 15% of total weight loss to reverse most weight-related health issues such as diabetes and high blood pressure, and this amount can be lost with diet, exercise and lifestyle changes.”

In fact, Dr. Scinta advises that gastric band surgery should be undertaken only as a last resort for people who have truly attempted a comprehensive approach:

“Even then, they will struggle long term without lifestyle changes. There is a reason why the post-surgical suicide rates are unexpectedly high.”

In a 2010 study published in the American Journal of Medicine, researchers examined the rate of suicide among bariatric patients in Pennsylvania over the course of 10 years. About 70% of these suicides occurred within the first three years post-op. Compared with data from matching age and sex groups, suicide rates among patients who had such surgery in Pennsylvania were “substantially higher than the general population”.

The mainstream media has not looked closely at this study, adds Sandy Szwarc, and many parents considering these surgeries for their teens may take at face value the reports of their safety and effectiveness and the claims that complications are minor compared to the risks of being fat.

What may be most telling, she reminds us, is why such needless risks — which are unheard of for any other elective surgery done on other children — are disregarded or seen as acceptable when discussing a procedure for fat children.

Read the rest of the Junkfood Science article by Sandy Szwarc, or read the Consumer Reports Health article called Think Twice About Lap-Band Surgery For Weight Loss

See also:

• Are You Being Over-Diagnosed?
• Catastrophizing: Why We Feel Sicker Than We Actually Are
• The Medicalization of Everyday Life