nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, September 23, 2010

Weight Loss Surgery For Teenagers...Not A Great Idea

Gastric banding is exploding among overweight adolescents...and accomplishes what, exactly?

A recent study in Pediatrics shows that--although not approved for those under 18--laparoscopic adjustable gastric banding (LAGB), is growing rapidly in obese teens.  The procedure applies a band around the upper part of the stomach,  that can be adjusted:
The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach.  As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps the person to be hungry less often, feel full more quickly and for a longer period of time, eat smaller portions, and lose weight over time (Wikipedia)

Classic gastric bypass surgery is more extensive.  In the bypass operation, the stomach is sewn to a lower part of the intestine so all food "bypasses" that part of the gut.

Banding is much more simply done.  The research article shows that there were no deaths among the ~600 patients (including both types of surgery), and complications were uncommon.

For Onion Peelers,
Overall, 590 adolescents (aged 13–20 years). Rates of laparoscopic adjustable gastric banding (LAGB) increased 6.9-fold from 0.3 to 1.5 per 100 000 population (P < .01), whereas laparoscopic Roux-en-Y gastric bypass (LRYGB) rates decreased from 3.8 to 2.7 per 100 000 population (P < .01).  The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations.

I grant that in the short term this procedure forces the individual to lose weight, but unless the idea is to keep the band in place for a lifetime, once it's removed, the problem recurs most of the time.  So, you spend about $20,000 to get thin for a couple of years, then go back to being overweight (recurrence rate is really high).

Some experts say you should combine the surgery with behavioral modification to get better results.  But if that's the case, why do the surgery part?  Just do the therapy.

I've written several times about the global problem of obesity.  Quick fixes waste a lot of resources and don't get at the root of the problem.

The real problem is the efficiency of our physiology.  As humans we adapted in the pre-historic environment to a subsistence level of existence where our bodies had to be able to use every calorie, from berries to carrion to tree bark.  Contrarily, those people who are naturally thin today would have been the first to die back then, in times of starvation.

Modern humanity has no defense against nutritional plenty.  Chemical messages sent to the brain that we've eaten enough are not instantaneous, and we keep eating until they arrive, shutting off the impulse to consume.  Combined with sedentary habits, we don't burn off the calories. 

[When I was active duty military I once had a recruit answer a health information form on "what kind of physical activity do you engage in regularly?" with the answer "video games."]

I once read an article that said pre-history humankind spent more time running than walking.  Maybe it's not true but you get the picture.  Our bodies are marvelous at storing calories and were adapted to being physically very active most of the time.

You can't fix that with gastric bands, and dietary laws.

What you can do for kids is get them active.  Most schools no longer spend any time doing physical training (about 20-30% do).  I'll bet an hour a day of physical exercise, games, training, etc would drop more pounds--and develop a habit of activity--than all the nutrition lectures, menu labelling, and medical treatments ever could.

Doc D

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