Given the large gap in success rates between surgical patients and non-surgical patients in the study, this research may shed some light on why some doctors argue that gastric banding is sometimes the best option for adolescents.
Dr. Mitchell Roslin, Kayla Maryles' surgeon at Lenox Hill Hospital, says that, "without a device, the kids are hungry. It's not a lack of willpower or education, it's the fact that when trying to lower caloric intake, they're hungry, and [the new behavior] can't be sustained."
"Our goal should be to prevent obesity with education and awareness," Roslin says, "but once it exists, we should aggressively treat it. Once they're in my office -- education has failed."
This also proved true in the study: though teens in the lifestyle-change program had a personal trainer for the first six weeks and group exercise activities to keep them motivated, only 12 percent were able to keep 50 percent of their excess weight off for two years.
"This study clearly shows what every obese teenager and their parents know," says Dr. Christine Fielding, director of the New York University Program for Surgical Weight Loss. "Conventional diet, exercise and behavior modification are dismally ineffective for the severely obese teenager."
Conversely, post-op teens who also had education programs teaching them how to eat healthily and properly (given their new, smaller stomachs) fared much better: 84 percent of these teens were able to meet the program goal.
"When we intervene with the device, we are making a physiological change" in the way the kids eat, Roslin says.
Roslin says the gastric band may give teenagers a physical advantage -- they feel more satisfied with less food -- but they also need to change their behavior, probably for the rest of their lives.
"The band doesn't change the fact that you need to watch what you eat," Roslin says.
"A lot of people think that it's the easy way out," Maryles adds, "but it's really just a tool and it's a matter of whether you use it the right way -- if you stay on top of your game to continue to lose weight."
While critics of early lap band surgery argue that it's jumping the gun -- operating before patients have serious medical conditions -- Roslin says that acting early can have a huge impact on both the physical and mental health of his patients.
"The world is a very cruel place for an obese adolescent. What people don't get is the cost to society of people not reaching their potential because of their obesity. It's harder to count, it's harder to predict, but if you see the teenager and see the change in how they carry themselves, it's as drastic as you can possibly imagine," Roslin says.
For Maryles, beyond improving her health, she says the weight loss has given her a new outlook on life.
"I feel I've gained this confidence, people who have known me for years say I have a different presence now," she says.
"Not that I wasn't happy before, but there's a different light about me now. I'm looking forward to being looked at for just me, and not the weight I have on my body."