Is Banding or Bypass Surgery Best for Obese Teens?

By Anna Wilde Mathews

scalesA new study in JAMA reports that teens who got bariatric surgery lost a substantial amount of weight. But the clinical trial only looked at one type of surgery — gastric banding, which involves wrapping a silicone band around the upper stomach to restrict food intake.

There’s another bariatric procedure, gastric bypass surgery, which typically involves creating a small stomach pouch and a passage so food bypasses the rest of the stomach and parts of the small intestine. The authors argued in their paper that gastric banding is more appropriate for young patients because it is safer than gastric bypass as well as being “adjustable and reversible.”

Paul O’Brien, the lead author, said in an interview that “the band is safe, whereas the bypass is not yet safe enough.” For teenagers, the option to remove the band later in life is important, partly because new treatment options may emerge, according to O’Brien. “The band I can back away from, the bypass I can’t back away from,” he said.

But that argument is likely to spark some debate, reflecting the back-and-forth that’s already common among surgeons over which procedure is best for adults. Another prominent researcher, Thomas Inge of Cincinnati Children’s Hospital, who is leading a major NIH-funded study of bariatric surgery in young people, said “the jury is out for the teens on which is going to be more effective.” He said bypass operations are “generally more effective for weight loss,” and that the safety question is “subject to interpretation.”

Inge and others note that in the past, the Australian group that led the new study has seen better results from banding than are typical in the U.S., partly because of the fractured U.S. health system and payment policies that can limit follow-up care.

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