Gastric Band for Kids 14-18?
Right now the laparoscopic gastric band, or "lap band," is FDA-approved only for people age 18 and older. But a new study is adding to the medical evidence that it could help much younger teens who have tried and failed to keep off excess weight with diet and exercise.

The research, conducted by Dr. Paul E. O'Brien and his colleagues at Monash University and the Royal Children's Hospital in Melbourne, examined severely obese subjects age 14-18. The group that had the lap band surgically implanted had better results than a group that took part in a "lifestyle management program," which included diet, exercise and other behavior changes.

"This is definitely a positive study," said Dr. Peter LePort, who practices in Fountain Valley, Calif., and is director of bariatric surgery (including the lap band and gastric bypass) at California's Orange Coast Memorial Medical Center. "I think it'll increase the number of adolescents who will get the band, and it'll increase the number who come in to request to have it, in the sense that if this gets known, it's a solution for patients who are 100 pounds overweight."

What is the lap band? It's a silicone band that is tightened around an upper portion of the stomach. The idea is to force the patient to eat less at a time, and to make the food pass into the larger section of the stomach and into the small intestine. Through an attached tube, the band can be tightened or relaxed to adjust the flow of food. Gastric bypass has proved to be more effective, but the lap band is less invasive (it's inserted through an incision in the abdomen), and it's both adjustable and replaceable.

This study follows one released last year from Columbia University in which 24 morbidly obese patients (meaning those with a body-mass index of 40 or higher) ages 14-17 showed improvement in BMI and other indicators a year after lap-band surgery. If further research confirms its safety and effectiveness, it might convince insurance companies to pay for the procedures for young people.

LePort said he has inserted lap bands into patients as young as 13, but since it's not FDA-approved for people that young, it's an "off-label" use of the device, meaning those patients generally must pay out of pocket - and waive liability.

"We have them sign a consent form that this is off-label, and we explain what that means - explain what the risks are and why," LePort said.

LePort said the band only helps the very heaviest people, because it's recommended for those with a BMI of at least 40, or 35 if the patient has co-morbidities like diabetes, cardiovascular disease or sleep apnea.

The study, published in The Journal of The American Medical Association, involved 50 teens who had a BMI of 35 or higher. (A 5-foot-10 person with that BMI weighs 244 pounds and would need to lose just over 70 pounds to push the BMI below 25, the threshold for "overweight," according to this calculator.) The subjects were monitored for two years, and during that time 24 of the 25 lap-band patients completed the study. Eighteen of 25 in the lifestyle group finished.

Twenty-one lap-band patients kept off at least 50 percent of their excess weight after two years, while only three lifestyle patients did so well. The lap-band group lost an average of 76 pounds (78.8 percent of excess weight), while the lifestyle group lost an average of 6.6 pounds (13.2 percent of excess weight).