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Gastric Band Surgery Offers Hope for Obese Teens

July 19, 2007 at 6:25 PM EST
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ELIZABETH BRACKETT, NewsHour Correspondent: Seventeen-year-old Taylor Hamrick and her mother arrived at the University of Illinois at Chicago’s Medical Center late last year to talk about a procedure they hoped would change Taylor Hamrick’s life.

DR. ALLEN BROWNE, Pediatric Surgeon: Any new problems?

ELIZABETH BRACKETT: At 257 pounds, Hamrick was already facing possible knee surgery because of her weight, and she had developed sleep apnea.

Fifteen percent of American teens are obese. That number has risen 300 percent in the past 30 years, says Dr. Allen Browne, medical director of the New Hope weight management program at the UIC Medical Center.

DR. ALLEN BROWNE: It affects their quality of life. It also affects them in their school performance. It affects them in many psychological ways, as well as clinical ways, in terms of sleep apnea, pre-diabetes, high blood pressure.

ELIZABETH BRACKETT: Because the health risks from obesity are so high for teens, Dr. Browne recommends adjustable gastric band surgery.

DR. ALLEN BROWNE: This is the adjustable gastric band itself. This is the tubing that connects the band to the reservoir that lives underneath the skin. Then we snap this in place like that around the stomach. We will put in a needle in here, through the skin, and with that we can blow this balloon up that’s on the inside of here. And that makes it harder for things to go from the upper pouch to the lower pouch.

The food goes through the normal pathway, and this is why there are no inherent vitamin, mineral, protein, nutritional issues associated with the band, because the food goes right through. This is strictly a portion control system.

ELIZABETH BRACKETT: Dr. Browne says adjustable gastric band surgery is less risky than a gastric bypass, where a small part of the stomach is permanently stapled and rerouted to the small intestine, limiting the amount of calories and nutrients absorbed.

In 2005, UIC Medical Center began the first FDA-approved study looking at the safety and effectiveness of gastric band surgery for teenagers. This spring, a multi-institutional industry-sponsored study aimed at securing FDA approval for the gastric band surgery for kids between ages 14 and 17 will begin.

TAYLOR HAMRICK, Surgery Patient: The peer pressure, wanting — you see all this media on TV of these little girls in bathing suits, and these Barbie doll images, and you want that.

ELIZABETH BRACKETT: Hamrick says she has lots of friends back home in Chattanooga, Tennessee. She went to her prom with them last year, but says even her best friends don’t realize how hard it is to be heavy.

TAYLOR HAMRICK: All my friends are, you know, little-bitty things, and it’s hard to find clothes and boys, and it’s been such a struggle.

LESLIE HAMRICK, Mother of Surgery Patient: There have been times when she has come in and I have held her because, unfortunately, some people have not seen the struggles that she’s gone through.

Defining eligibility for surgery

ELIZABETH BRACKETT: To be eligible for gastric band surgery, teenagers in the study must be in the 95th percentile for weight for their height and age, weigh between 250 and 500 pounds, and have little hope of reversing their obesity.

DR. ALLEN BROWNE: Once your weight is over 95th percentile for your age and gender, and you're a teenager, your chances of that changing spontaneously without some sort of therapy are in the category of maybe 10 percent, 20 percent at most.

ELIZABETH BRACKETT: Dr. Browne meets regularly with a clinical team that coordinates pre- and post-surgical care. Each patient has a nutritionist, a counselor, and a physical therapist. Six weeks after her initial visit, Hamrick was prepped for surgery.

TAYLOR HAMRICK: I'm really not nervous at all. I'm ready to get it over with.

ELIZABETH BRACKETT: Moments later, Hamrick was on her way to the operating room. On the table, five small incisions were made. Then, the laparoscopic camera was inserted.

DR. ALLEN BROWNE: Need to turn the movie on.

ELIZABETH BRACKETT: Next, two instruments, which became an extension of Dr. Browne's hands. The gastric band was pushed through an incision and the most delicate part of the surgery began: manipulating the band behind the stomach. Once the band was brought together, it was locked.

DR. ALLEN BROWNE: It's a cross-handed maneuver.

ELIZABETH BRACKETT: And the stomach was then sewn over the band to hold it in place. The tubing connected to the band was then brought to the surface and a permanent port inserted to be used in future adjustments. It was all done in just an hour. Then, Dr. Browne spoke with the family.

DR. ALLEN BROWNE: We made the stomach into an hourglass, like a snowman with a big little top and a big bottom. And so that's what -- we'll be utilizing that later on, because we'll fill up the upper part, which sends a signal to her brain which says, "You're full."

Discussing effective treatments

ELIZABETH BRACKETT: Hamrick is the 23rd patient in the UIC Medical Center study to get a gastric band. Dr. Browne says preliminary results for those patients are positive.

DR. ALLEN BROWNE: They will lose about 30 percent -- down to about 30 percent of their excess weight in the first year. And then over the next couple years, they'll ease on up to about 50 percent or 60 percent excess weight.

ELIZABETH BRACKETT: The results were similar to those recently reported in the Journal of Pediatric Surgery, from a separate study on gastric band surgery for adolescents done at NYU Hospital. Eighteen months after surgery, those teens had lost half of their excess weight on average.

But not all doctors endorse gastric band surgery. Dr. Vivek Prachand, a surgeon at the University of Chicago hospitals, does about 230 surgeries for weight loss on adults per year. He says gastric bypass surgeries are more effective, particularly for the heaviest patients. Prachand's patients lose 60 percent to 70 percent of their excess body weight the first year after surgery.

DR. VIVEK PRACHAND, Surgeon: It may be a more effective treatment for some of the obesity-related medical problems, such as diabetes, high blood pressure, abnormal cholesterol. And certainly one of the important goals of these operations is not just to achieve good weight loss, but it's also to achieve resolution of these other medical problems.

DR. ALLEN BROWNE: Bariatric surgery in adolescents and children is new. And we're all learning. So I respect this person's opinion. I know where he comes from. But, on the other hand, we have data that would conflict with that, so we decided that we would start out with the safest procedure, with a procedure that was reversible.

A better quality of life

ELIZABETH BRACKETT: Eighteen-year-old Hilary Agusto was the second patient in Dr. Browne's study. Before her gastric band surgery two years ago, Agusto weighed 253 pounds.

HILARY AGUSTO, Surgery Patient: I tried just eating less, first of all. Then I went to L.A. weight loss, and then I tried a soup diet or a celery diet, everything.

ELIZABETH BRACKETT: And none of it worked?

HILARY AGUSTO: No. Like it worked for a while, and then I just gained it back.

ELIZABETH BRACKETT: She has lost 77 pounds since her surgery, and she's changed her eating habits.

HILARY AGUSTO: I could eat, like, half a large pizza. And now I can barely eat a whole slice.

ELIZABETH BRACKETT: And are you hungry still?

HILARY AGUSTO: No, I'm definitely like very content with myself after eating not even a whole piece of pizza.

ELIZABETH BRACKETT: More importantly, Agusto says the surgery, plus counseling and physical therapy, have changed her self-image.

HILARY AGUSTO: I'm just a happier person. I'm able to do what I want. I'm able to go shopping, which is fun, so it's happy.

ELIZABETH BRACKETT: Six weeks after her surgery and 15 pounds lighter, Hamrick came back for her first band adjustment.

DR. ALLEN BROWNE: Ready? Little mouthful. Move your hand out of the way. Swallow down.

ELIZABETH BRACKETT: Before the adjustment, the barium Hamrick is given to drink goes right to her stomach. Once her band is tightened by injecting air into it, the barium stays in her upper stomach longer, just as food would.

DR. ALLEN BROWNE: Feel it empty out. Yes, isn't that wild? Isn't that wild?

ELIZABETH BRACKETT: All gastric band patients have their bands adjusted three to four times a year as they lose weight. The bands can be removed, but Dr. Browne says most patients will need to keep them on for life. For the Hamricks, it's a small price to pay, measured in part by the size of a prom dress.

TAYLOR HAMRICK: I'm just really excited. Prom's coming up, so I'm looking forward to a smaller dress size this year. I'm really excited about that.

ELIZABETH BRACKETT: Gastric band surgery costs $15,000 to $20,000, and insurance doesn't pay for it for teens. That could change if the procedure is approved by the Food and Drug Administration, but that approval is at least one to two years away.