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BMJ 2010; 340 doi: (Published 18 February 2010) Cite this as: BMJ 2010;340:c935

Preliminary trial supports bariatric surgery for teenagers

Bariatric surgery is a controversial treatment for obese adolescents. Surgeons, parents, policy makers, and third party payers continue to argue over the evidence, which is generally poor. An Australian team recently added a much needed randomised trial to the mix. It was small (n=50) and compared adjustable gastric banding with a generous lifestyle intervention based on education, diet, and exercise. Surgery worked significantly better over two years of follow-up.

This trial is important, says an editorial (p 559), because it tells us that randomly allocating adolescents to surgical or medical options is at least feasible. These researchers managed to recruit 50 well motivated adolescents with a mean body mass index (BMI) over 40. Exactly half had laparoscopic surgery. They lost 78.8% of their excess weight over two years (95% CI 66.6% to 91.0%; 12.7 BMI units, 11.3 to 14.2). The 25 controls lost a mean of 13.2% of excess body weight (2.6% to 21.0%; 1.3 BMI units, 0.4 to 2.9), although only 18 completed follow-up.

Markers of cardiovascular risk improved more after surgery. So did some measures of quality of life. The main trade off was a relatively high rate of revision procedures. In this trial, seven adolescents needed further surgery—mostly removal and replacement of the band after pouch dilation, heartburn, reflux, or vomiting.

Fetal growth in the first trimester has far reaching implications

We already know that what happens to babies in the womb has implications way beyond birth. The first trimester seems particularly important, according to the latest analysis of data from an established cohort in the Netherlands. Researchers found a link between poor growth in the first trimester and adverse birth outcomes in 1631 pregnant women with reliable dates. They also recorded accelerated growth in infancy for these babies, who seemed to be “catching up” growth they had missed in the first trimester. Rapid growth …

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