Adolescent obesity is a vexing problem for which there are few good solutions. Obese children develop metabolic syndrome. Because the cardiovascular complications of metabolic syndrome result from many years of exposure to hyperglycemia, diabetes, hyperlipidemia, and hypertension, early onset of these problems portends significant disease later in life.1 For these reasons, treating adolescent obesity is important.
How can sustained weight loss be achieved in children and adolescents? As with adults, effective treatments are lacking. Bariatric surgery has been proposed for children but remains controversial. Evidence in support of these operations is based on small-scale studies that have mostly emanated from single institutions reporting outcomes from small numbers of patients with inadequate follow-up.2 Most studies have investigated gastric bypass–type procedures. Because these operations permanently alter the stomach, most clinicians are reluctant to advise these operations for children or adolescents except in the most compelling circumstances. Laparoscopic adjustable banding operations have become popular in recent years because these procedures can result in reasonable weight loss with relatively few complications and substantial potential for reversibility. As with adult bariatric surgery, the literature supporting the use of bariatric procedures is incomplete, causing policy makers to be hesitant in recommending this procedure for treatment of adolescent obesity.