Allowing teens to have weight loss surgery is often viewed as a questionable choice, but for 21-year-old Kayla Maryles, who underwent gastric band surgery in December of 2008, it's a choice she would gladly make again.
And she may not be alone -- gastric banding, a laparoscopic procedure that places an adjustable band around the stomach to limit its size, is becoming more common among obese teens. What's more, new research suggests that the procedure is much more effective at helping them lose weight than diet and exercise alone.
Maryles, currently a senior at the University at Buffalo, had struggled with her weight since early childhood. She was physically active and involved in sports, but by the time she was 20, she weighed 250 pounds.
After her mother had surgery and successfully lost weight, Maryles decided to try gastric band surgery.
"I was hesitant as to whether I should have it -- I was always active and I was so young," Maryles says, but a year later she has lost 72 pounds and says she is "really happy" with her decision.
The surgery was painful, she says, but "it was not unbearable -- I would gladly do it over again three times [to get these results]."
Though the FDA is considering broadening its standards on gastric banding to include teens aged 14 to 17, the procedure is currently approved only for adults. Doing the operation on teens is not prohibited, but it is considered off-label use -- and it is hotly debated among doctors.
But new data may help shift the debate in favor of surgery. When compared with those in diet and exercise programs, gastric band patients lose over ten times as much weight after two years, a new study finds.
The study, published Tuesday in the Journal of the American Medical Association, is the first of its kind to compare behavioral weight loss interventions in teens to gastric band surgery.
In the study, fifty obese teens, aged 14 to 17, were randomly assigned to receive the surgery and post-op diet training -- or to have no surgery and go through intensive diet and exercise programs.
Two years into the study, the gastric banding group had lost an average of 76 pounds while the lifestyle group had only lost an average of 6.6 pounds -- with some actually gaining weight during the program.
But does that justify the risks of surgery?
Unlike gastric bypass or stomach stapling, gastric banding is a less-invasive, laparoscopic procedure. The band around the stomach can be adjusted or removed by a doctor.
Nonetheless, there were still a considerable number of surgical complications in the study -- one in three patients required follow-up surgeries.
"These teens are expected to keep the band for 60-plus years," says Dr. Jonathan Schoen, bariatric surgeon at the University of Colorado Hospital. He says the safety of the surgery is "something entirely unproven. There is no doubt that bariatric surgery has a very important role in adolescent morbid obesity. However, which operation will provide the best and longest-term outcome is still a matter of much debate."
David Arterburn, assistant investigator at the Group Health Research Institute, agrees, adding that "adolescents should be well-informed regarding the high likelihood of needing a repeat operation" when deciding whether to take the plunge and try surgery.
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."