Selling an elective surgery

Recreational cosmetic surgeries may be all the rage, but some are especially dangerous. Most worrisome, some elective surgeries are even being promoted for growing children without any evidence of long-term safety.

An intense marketing campaign is underway to promote lap band surgeries for American teenage children. These bariatric procedures have not received FDA approval, although that may come as a surprise to most of the public given how often these experimental procedures have been in the news. Clinical trials are being conducted at certain bariatric surgical centers as part of the NIH-funded study, Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), and the studies will no doubt be used to convince the FDA of their effectiveness. One such study was done at New York University Medical Center and the results were recently published in the Journal of Pediatric Surgery.

The Medical Center’s press release, titled “Lap Band Surgery Helps Obese Teens: Study,” was circulated by the American Obesity Association and published verbatim across the country through health information news services and national newspapers such as the Washington Post. The news stated: “Stomach banding, commonly called lap band surgery, is a safe and effective method of helping obese adolescents lose weight, U.S. researchers report.”

Another promotional story circulated across the country today, noting that bariatric surgeries are becoming more common among U.S. children. The article described gastric lap bands for children as holding “promise” based on that same study at New York University Medical Center.

The mainstream media has not looked closely at this study, nor has the medical literature, and many parents considering these surgeries for their teens, and referring physicians, may take at face value the reports of their safety and effectiveness and the claims that complications are minor compared to the risks of being fat.

This study was led by Dr. Evan Nadler and reported the short-term weight loss results of 53 teens who had undergone lap band surgery at their center since 2001. Most were girls about 16 years of age. It has been well-founded that weight loss rebounds within 5 years in almost all weight loss interventions, making the 18 months reported in this study insufficient to demonstrate any lasting effectiveness. In fact, the average weight loss was already rebounding among these patients, with a nearly 25% regain since their 1 year weight loss!

For clinical trials, patients are carefully selected and followed much more closely than in the real world where mortality and morbidity rates have been found to be considerably higher than in this study and those quoted in these news reports. Still, nearly 10% of these children in this study required second surgeries due to complications although, thankfully, none died.

But a finding that was downplayed in the news was that nearly one in five of the teens were already having and showing signs of nutritional deficiencies, boding extreme concerns for the long-term health of these growing children. [Note, these children had lap band surgeries. The claim that lap bands don't affect nutrition is a myth.] Four already had iron deficiency anemia, which is reported in 30-50% of adult bariatric patients and highest among menstruating women, despite supplementation and another five had hair loss, a sign of malnutrition.

It may be easy to not grasp the seriousness of nutritional deficiences because these disorders have become so rare in Western societies that we don’t witness their long-term aftermath. But conditions primarily seen in starvation-ridden countries and serious or terminal illnesses are now being reported among bariatric patients, from crippling osteoporis, immunological problems, developmental delays to brain damage. For example, in 2004 doctors began reporting cases of beriberi already showing up in teenagers after bariatric surgery, such as the study in the Journal of Pediatrics by doctors from Cincinnati Children’s Hospital Medical Center. Beriberi is caused by thiamine deficiency typically seen in starvation and severe alcoholism. It can result in memory loss and dementia, growth retardation and learning difficulties, congestive heart failure, neurological damage that’s usually irreversible, and death.

What may be most telling is why such needless risks — which are unheard of for any other elective surgery done on other children — are disregarded or seen as acceptable when discussing a procedure for fat children.

© 2007 Sandy Szwarc