More pint-sized patients getting grown-up surgeries

Childhood obesity rates are through the roof. In the past 30 years, the percentage of overweight kids has nearly tripled in every age group, according to the Centers for Disease Control and Prevention. (Obesity in children is defined as a body mass index, BMI, at or above the 95th percentile for children of the same age and sex.) The extra pounds put kids at higher risk of asthma, heart disease, fatty liver, type 2 diabetes, and sleep apnea. As physicians and parents alike grapple with how to help these super-sized kids, it's no surprise that adult-sized surgeries are being re-tooled to fit younger and younger patients.

In the first study of its kind, surgeons performed weight-loss surgery on a group of morbidly obese teenagers in hopes of reversing early signs of chronic disease. In the study, published this month in the Journal of the American College of Surgeons, 50 adolescents ages 14 and 15 underwent a common weight-loss procedure using laparoscopic adjustable gastric banding. Prior to the surgery, the teens had a mean weight of 299 pounds and BMI of 48. (A BMI of 30 or more is considered obese in adults.) During the operation, surgeons placed an adjustable band around the stomach, creating a small pouch in the upper portion. The size of the band's opening controls the passage of food between the stomach's top and bottom sections. With the top section filling quickly, the idea is that a person reaches satiety sooner, eats less and loses weight.

Surgeons followed the teens for the next two years. The teens lost weight and experienced health boons on par with those seen in adults, such as decreases in back pain, depression, and hypertension and increases in blood sugar regulation. That last one is especially important because better regulation of blood sugar helps stave off type 2 diabetes, a common and serious side effect of obesity. "This study is the first to show the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents," said Evan Nadler, MD, lead author and a pediatric surgeon at Children's National Medical Center in Washington, DC.

In another case of grown-up surgery for kids, plans are underway at six research centers nationwide to test whether or not a popular sleep apnea surgery is useful for children. Up to 30% of overweight or obese children have obstructive sleep apnea, a sleep disorder characterized by a lack of airflow. Specifically, breathing periodically stops during sleep for at least 10 seconds, causing a dip in blood oxygen levels. Study investigators, funded by the National Institutes of Health, plan to enroll 500 children between the ages of 5 and 9 and compare the outcomes of those who undergo surgery versus those who receive non-surgical treatment, such as nasal spray. Additionally, researchers will look to see if sleep apnea is linked to learning problems, attention deficit hyperactivity disorder, and pre-diabetes.