Surgery could help them avoid long-term complications of blood sugar disease, scientists say. But changing the diet and increasing physical activity can have the same results. Is this really a magic pill? What happens over time?
Obese teenagers who have gastric bypass surgery not only lose weight but see their type 2 diabetes disappear, a new study finds.
Also called bariatric surgery, the procedure works by limiting the size of the stomach and thereby reducing the amount of food one can eat. In this study, researchers used the Roux-en-Y method, which involves placing an adjustable band to block off most of the stomach. The band limits how much food the body absorbs.
“Previous studies have shown frequent remission of type 2 diabetes in adults following bariatric surgery, but until now, no research had been done to provide information about outcomes of adolescent diabetics who are considering surgical weight loss,” said lead researcher Dr. Thomas H. Inge, an associate professor of surgery and pediatrics at Cincinnati Children’s Hospital Medical Center.
“Our study found that, in most cases, teens can lose one-third of their weight and come off diabetes medications with remission of their diabetes one year after bypass surgery. This is certainly not the case for similar diabetic teenage patients who did not undergo surgery,” Inge noted.
For the study, Inge’s group looked at 78 teens with type 2 diabetes. Eleven patients underwent gastric bypass surgery, while the other 67 patients received usual care for their diabetes.
For the teens who had surgery, not only did they have an average 34 percent reduction in their weight, but their diabetes went into remission. Teens that did not have surgery saw an average weight loss of less than two pounds and still needed their diabetes medication.
“In addition to the impressive weight loss and type 2 diabetes results, patients undergoing the gastric bypass surgery also showed significant improvement in blood pressure, insulin, glucose, cholesterol and triglyceride levels,” Inge said.
Type 2 diabetes takes a huge toll on the body, and the earlier it starts, the more of an impact it can have, Inge explained.
“These early surgical research findings suggest that diabetes may not be a diagnosis kids have to live with for the rest of their lives,” Inge said. “They may not have to face diabetic retinopathy, progressive coronary heart disease and renal failure. In fact, there is good reason to be optimistic about their future cardiovascular health.”
“If you are a type 2 diabetic and morbidly obese, gastric bypass surgery should be considered in the treatment pathway,” Inge added.
Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks that while surgery is effective it does not deal with the cause of the obesity epidemic among teens.
“Bariatric surgery is clearly effective in treating severe obesity, preventing and reversing type 2 diabetes, and even extending survival when applied to adults,” Katz said. “That similar benefits ensue when the procedure is applied to adolescents is important, but by no means surprising.”
Despite the success of surgery, these results should be viewed with caution, Katz said.
“A large and growing proportion of all children and adolescents are subject to obesity, and its complications,” Katz said. “Surgery can mitigate those complications, but can we really condone ushering more and more young people through the OR doors for a major surgical procedure to fix what policies and programs that foster healthful eating and regular activity could have prevented in the first place?”
Gastric bypass surgery is an effective last resort for severe obesity in adolescence, as in adulthood, Katz said. “But a last resort it should be, and we should do all we can to minimize the need for this procedure by combating the root causes of obesity in our society.”
Thomas H. Inge, M.D., Ph.D., associate professor, surgery and pediatrics, Cincinnati Children’s Hospital Medical Center; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; January 2009 Pediatrics