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 Obesity

Columbia University Center for Metabolic and Weight Loss Surgery
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Surgical Weight Loss Program Provides LapBand® Surgery for Eligible Teens

Center for Adolescent Bariatric Surgery
Center for Adolescent Bariatric Surgery
Amanda Baron, age 17, weighed about 250 lbs when Dr. Zitsman performed her LapBand surgery in June 2007. Since then she has lost over 60 lbs, and her hypertension and knee pain have disappeared.

Established in 2006, the multidisciplinary Center for Adolescent Bariatric Surgery has conducted 34 successful weight loss surgeries in teens as of December, 2007. With its extensive expertise and leadership in the field of bariatric surgery, the center is one of only a few U.S. centers presently approved to offer weight loss surgery to adolescents.

The center is geared toward obese teens who would be considered good candidates for laparoscopic gastric band surgery, focusing on those with a body mass index (BMI) of 40 or greater. Patients may also be eligible if they have a BMI of 35 or greater and associated medical conditions such as diabetes, hypertension, sleep apnea, or polycystic ovary disease.

Candidates must have completed a documented weight loss program such as Weight Watchers, Curves, or a private program supervised by physicians and nutritionists, according to Jeffrey L. Zitsman, MD, Director, Center for Adolescent Bariatric Surgery, Morgan Stanley Children's Hospital of NewYork-Presbyterian/Columbia. Obese adolescents who have not lost weight through these programs are evaluated for several months by members of the multidisciplinary team, which includes experts in pediatric gastroenterology, endocrinology, nutrition, psychiatry, surgery, and other specialties. In addition to thorough medical, psychiatric, and exercise tests, candidates undergo sleep studies because of the high rate of sleep apnea among obese individuals. Based on all of these evaluations, candidates may be offered surgery if they meet medical criteria and have shown solid compliance and weight loss effort.

The center performs only one procedure in adolescents, laparoscopic gastric banding, or LapBand®. This minimally invasive procedure consists of the placement of an inflatable flexible band around the stomach to divide it into two pouches. After the band is in place, the smaller upper pouch limits the amount of food that can be eaten, and patients can lose weight as a result. Because the band may be adjusted or even removed any time after it is placed, laparoscopic banding poses a minimal risk of malnutrition, and because the procedure involves no incisions in the stomach or intestines, many physicians consider LapBand the safest and best weight loss procedure for adolescents.

After surgery, most patients recover very quickly with only minor pain, and are up the day of surgery. Almost all begin losing some weight immediately, and then can expect to continue to lose their excess weight gradually over the first three years, according to Dr. Zitsman. Patients receive prophylactic medication to prevent nausea, which might otherwise occur during the first days after surgery. "Patients are all a bit surprised when they feel full so quickly," says Dr. Zitsman. "If they eat too much, they may throw up. But they quickly become more aware of what they are eating," he says. Nutritionists at the center work with patients and their families to develop healthy, meal-focused plans in order to discourage binge eating, emotional eating, and 'grazing,' which can hinder weight loss efforts. In published studies of LapBand patients, over 75% of patients have lost more than 50% of their excess weight and have a BMI in the upper 20's after three years.

The adolescent LapBand protocol is available as part of an FDA approved study in which the center documents the results of surgery and compares them to nonsurgical attempts at weight loss. Dr. Zitsman serves on the Committee on Childhood Obesity of the American Pediatric Surgical Association, as well as the Childhood Obesity Committee for the American Society for Bariatric and Metabolic Surgery. Along with colleagues at NewYork-Presbyterian Hospital, Dr. Zitsman is studying the impact of obesity and weight loss surgery on the family, as well as attitudes towards weight loss that affect patients' readiness to make a change in their lives.


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