Bariatric surgery in extremely obese adolescents
was shown to be effective in helping to reverse previously undiagnosed
cardiovascular abnormalities believed to be linked to severe obesity, says
study published in the Journal of Pediatric Surgery.
The study included a retrospective analysis of 10
adolescent patients (nine female) from Nationwide Children's Hospital who
underwent weight loss surgery between August and December 2008. High fidelity
imaging using cardiac magnetic resonance (CMR) was performed on these patients
in the months leading up to bariatric surgery and revealed heart abnormalities
(such as increased left ventricular mass, left ventricular dilation,
hypertension) in all patients.
"What we found was that the cardiac structure and
function in these extremely obese adolescents scheduled for bariatric surgery,
was much more impaired than one might have thought," said study co-author John
Bauer, PhD, principal investigator in the Center for Perinatal Research at The
Research Institute at Nationwide Children's Hospital. "In addition, more than
half of the patients we looked at had significant cardiac abnormalities that
would be on par with a middle-aged person with real cardiovascular disease risk
in the short term."
Within the first post-operative year (mean range
of 7-13 months), patients were re-evaluated using CMR. Results showed that
their previously recorded cardiovascular abnormalities were reversed.
"Many of the abnormalities that we documented
during the initial baseline study showed significant improvement after the
weight loss had been obtained," said the study's co-author Marc Michalsky, MD,
surgical director of the Center for Healthy Weight and Nutrition at Nationwide
Children's Hospital. "This is a small, preliminary study that shows the
significance of cardiovascular abnormalities in morbidly obese teens and that
additional, more robust investigations are needed to understand how weight loss
surgery can help this patient population."
In the Center for Healthy Weight and Nutrition at
Nationwide Children's, patients first go through several months of evaluation
to see if they are even candidates for weight loss surgery. This includes an
introductory information session attended by the adolescent and parent and
assessments of the potential candidate by a number of staff in the Center including
dieticians, bariatric nurse practitioners, psychologists, physical therapists
and surgeons. Candidates for weight loss surgery are those that have gone
through several failed attempts at diet and exercise regiments. These teenagers
have significant organ damage and their quality of life is poor, Dr. Michalsky
"Bariatric surgery in adolescents is never a
cosmetic procedure," explained Dr. Michalsky who is also a faculty member at
The Ohio State University College of Medicine. "These teens are very sick, they
are suffering and they can truly benefit in overall health from weight loss
Nationwide Children's is one of a few centers in the
country involved in long-term clinical research of adolescent bariatric
surgery, looking not only at what happens in the short-term post-surgery, but
long-term as well.