Surgical and Non-Surgical Treatment Options

Nov 29, 2006


About 15 percent of American children are obese, a number that has more than doubled in the last 20 years. In response to this epidemic, Morgan Stanley Children's Hospital of NewYork-Presbyterian has opened the Center for Adolescent Bariatric Surgery in order to offer numerous strategies to help obese patients lose weight and thus prevent many of the serious health risks associated with obesity. As part of the program, obese children have the option of losing weight with and without surgery.

Morgan Stanley Children's Hospital is the only children's hospital approved by the FDA to place adjustable gastric bands in patients younger than 18 years of age. There are approximately 50 patients currently enrolled in the program.

"Most young patients initially come to the program for treatment of pre-diabetes or insulin resistance, heart problems, joint problems, or other complications associated with their obesity," says Dr. Marc Bessler, surgical director of the Center for Obesity Management at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons. "Like adults who receive treatment for obesity, adolescent patients undergo rigorous education and a lengthy program of multidisciplinary, non-surgical therapies. Nevertheless, nearly 90 percent of adolescents with a body mass index (BMI) greater than 40 are ultimately unable to achieve or maintain adequate weight loss despite intensive medical regimens. For these patients, the new program offers laparoscopic adjustable gastric banding (LAGB), which studies have shown to be the safest and least traumatic surgical procedure."

Studies show that in adults, the risks of remaining obese far outweigh the risks of current surgical procedures; morbid obesity is associated with reduced lifespan and a host of serious conditions including diabetes, heart disease, pulmonary complications, respiratory compromise, liver and endocrine dysfunction, and major socioeconomic consequences.

"Obesity is often a fatal disease in the long term. If we can interrupt the progression in young patients before irreversible damage is done we will have done a very good thing," says Dr. Jeffrey L. Zitsman, director of the Center for Adolescent Bariatric Surgery at Morgan Stanley Children's Hospital and associate professor of surgery at Columbia University College of Physicians and Surgeons.

According to Dr. Zitsman and the Center's Medical Director Dr. Ilene Fennoy (associate attending pediatrician at Morgan Stanley Children's Hospital and associate professor of pediatrics at Columbia University College of Physicians and Surgeons), the program has chosen to perform LAGB rather than other types of bariatric surgery because it is completely reversible, it does not reroute patients' digestive anatomy, and the laparoscopic technique is minimally invasive.

Nevertheless, even this attractive option requires significant changes in adolescents' diets and lifestyles, and conclusive study has not determined the long-term effects in children's lives. According to Dr. Charles J.H. Stolar, chief of the Division of Pediatric Surgery at Morgan Stanley Children's Hospital and the Rudolph N. Schullinger Professor of Surgery at Columbia University College of Physicians and Surgeons, "The management of weight loss in adolescents is new-enough territory that much remains to be learned about how to best treat young patients." Until now, individual physicians have generally followed the criteria for adult patients in determining eligibility for surgery: a body mass index (BMI) of 40 or above, or 35 with significant illness associated with obesity. This guideline for children is being re-evaluated.

At Morgan Stanley Children's Hospital and other FDA-approved hospitals, pediatric LAGB surgery is currently available only to children 14 and older. Younger patients enroll in non-surgical weight-loss programs.

Current research suggests that the increased incidence of obesity in children and adolescents stems from a number of factors, including lack of physical activity, heredity, socioeconomic status, eating habits, environmental factors and underlying genetic, hormonal and metabolic syndromes or conditions. Over the past 20 years, the proportion of overweight children ages 6 through 11 has more than doubled and the rate for adolescents ages 12 through 19 has tripled.

Morgan Stanley Children's Hospital is one of several major children's hospitals conducting careful safety study of weight-loss surgery in adolescents. Because the Hospital has physicians with expertise in every specialty – including pediatric gastroenterology, endocrinology, nutrition, psychiatry, diabetes and surgery – patients can be assured that they are receiving the highest level of care available.

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Bryan Dotson