This news release summarizes an Australian study of the effect of laparoscopic adjustable gastric banding surgery (placing an adjustable silicone band around the top part of the stomach) on 21 severely obese adolescents. The release states that two-thirds of the teens lost significant amounts of weight for up to five years and further describes the procedure as “a first option” to manage obesity during adolescence.
Researchers quoted in the text repeatedly and appropriately cautioned that the procedure “is not for everyone” and requires careful management, but the release remained determinedly cheery about the outcome. Importantly, it also failed to acknowledge the small sample size in this study and the lack of a control group, as well as the health complications that stymied a few of the participants. Also ignored was that one-third of the 21 participants either failed to lose weight or began to regain it over the course of the study. Lap band surgery for severely obese teens is clearly no panacea.
Obesity is a major health problem the world over, with nearly 14% of American teens identified as obese (2015 Youth Risk Behavior Surveillance System). Obesity brings with it significant physical and psychological problems, with teenagers extremely susceptible to the latter and looking for solutions that do not require behavior change. Any text advising a surgical solution for a non-surgical problem in adolescents must be grounded in sufficient data and, with even that caveat fulfilled, must be cautiously worded to make it clear that most overweight teens would be inappropriate candidates for the procedure. This release fails the first test and does not seem sufficiently worried about the second.
The cost of this surgical procedure is missing in action in this release. This is a problem, because costs in the US, as of 2015, average more than $14,000.
We give this a tepid “satisfactory.” The release specifies the range of BMI loss for individuals in the study but never gets around to explaining what BMI is or how a reader should interpret the numbers. As discussed in more detail in the Evidence section below, the release doesn’t share that a third of patient volunteers had the laparoscopic bands removed due to no change in weight loss or regained weight.
Although the study on which this release was based did reference “minor complications” and symptoms that required removal of the bands among some participants, the release ignores this information.
The release misleads readers a bit here. It identifies a sample size of 21 teenagers in the study. That is an accurate count of individuals at the very beginning of the study. But the research report then notes that the all-important follow up data, on which the analysis was based, were ultimately available for only 16 of those individuals. And it also specifies that, in seven cases, the laparoscopic bands were removed at some point in the follow up period because individuals either failed to lose weight or began to regain weight. This suggests that the procedure did not work for at least a third of that already small group of 21.
The release also mentions that adolescents with depression were excluded from the study but we’re not told how often those exclusions occurred.
The text makes clear that this strategy would be relevant only for severely obese teenagers and then goes on to define that term. But the definition (body mass index over 40/kg/m2 or over 35 kg/m2) will be difficult for the average reader to understand.
Funders are not mentioned in the release although that information is provided in the text of the journal article. The study coauthors all claim no conflicts of interest, but that information is not provided either.
The release states through a quote from the lead author of the study that the lap band procedure “is a good result when compared to BMI reduction using the few medications available or lifestyle measures,” but offers no actual comparisons with any non-surgical approaches to weight loss.
It is clear that lap bands are now in use. The question posed here is whether they would be appropriate for seriously obese teenagers.
The release makes it clear that this study’s novel contribution is its effort to gather date from “lap-banded” patients over longer periods of time than did previous studies.
The researchers use terms such as “safe” and “effective” to describe the outcome of the banding process. This was apparently not true for at least a third of the sample. Sources in the release do emphasize the use of lap bands as a temporary option for teens, an important point.