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Department of Surgery Referrals Patient Clinician Researcher

Columbia University Center for Metabolic and Weight Loss Surgery
Pediatric Center

Pediatric Obesity Program: New multidisciplinary program
helps adolescents lose weight with and without surgery

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With the prevalence of obesity reaching epidemic proportions, hospitals and physicians must devise new strategies to help younger and younger patients overcome the disease. An ambitious new Pediatric Obesity Program at the Morgan Stanley Children's Hospital of NewYork-Presbyterian (CHONY) promises to help establish new standards of care in this evolving field.

Most young patients initially come to the Pediatric Obesity Program for treatment of diabetes, heart problems, bone loss, or other complications associated with their obesity. Like the adults who receive treatment in the adult obesity center at Columbia, adolescent patients under go rigorous education and a lengthy program of multidisciplinary, non-surgical therapies. Nevertheless,"87% of adolescents with a body mass index (BMI) over 40 are ultimately unable to achieve or maintain adequate weight loss despite intensive medical regimens," according to Marc Bessler, MD, Surgical Director, Center for Obesity Management, New York-Presbyterian Hospital/Columbia. For such patients, the new program will offer LAP-BAND™, the safest and least aggressive surgical procedure.

Studies clearly show that in adults, the risks of remaining obese far outweigh the risks of current surgical procedures; morbid obesity is associated with reduced life-span and a host of serious conditions including diabetes, heart disease, pulmonary complications, respiratory compromise, liver and endocrine dysfunction, and major socioeconomic consequences. "Obesity is often a fatal disease in the long term. If we can interrupt the progression in young patients before irreversible damage is done we will have done a very good thing," says Jeffrey L. Zitsman, MD, Director of Minimal Access Surgery, Children's Hospital of New York-Presbyterian Hospital. According to Dr. Zitsman, the program has chosen to perform LAP-BAND™ rather than other types of bariatric surgery because it is completely reversible, it does not reroute patients' digestive anatomy, and the laparoscopic technique is minimally invasive.

Nevertheless, even this attractive option requires significant changes in adolescents' diets and lifestyles, and conclusive study has not determined the long-term effects in children's lives. According to Charles J.H. Stolar, MD, Chief, Division of Pediatric Surgery, Children's Hospital of New York-Presbyterian Hospital, "The management of weight loss in adolescents is new enough territory that much remains to be learned about how to best treat young patients." Until now, individual physicians have generally followed the criteria for adult patients in determining eligibility for surgery: a body mass index (BMI) of 40 or above, or 35 with significant illness associated with obesity. Whereas adults may willingly choose to under go surgical procedures and accept their consequences, the issue of performing weight loss surgery in adolescents remains controversial. According to Dr. Bessler, "Unanswered questions remain about which patients should under go surgery, which operation is best, and what the long-term consequences really are." Physicians are not certain that the same standards should apply to adolescents as adults in determining who should under go surgery, for instance. "There are important differences between adult and adolescent patients, such as the proportional degree of body fat, metabolic rates, growing bones, and the presence or absence of effects from decades of smoking or carrying around the extra weight," explains Dr. Zitsman.

Paul Berk, MD
Marc Bessler, MD
Michael J. Devlin, MD
Ana Diaz-Zubieta, PhD
John Driscoll, MD
Ilene Fenoy, MD
Judith Korner, MD
Joseph Levy, MD
Rudy Liebel, MD
Sharon Oberfeld, MD
Charles Stolar, MD
Ileana Vargas, MD
B. Timothy Walsh, MD
Christine Williams, MD
Jeffrey Zitsman, MD

To obtain answers to such pressing questions, the program will be conducting comprehensive, long-term study of the effects of bariatric surgery in the pediatric population. "The pediatric obesity program is a very well organized, systematic, step-by-step, multidisciplinary approach to weight loss in adolescents," says Dr. Stolar. "The parallel experience would be the way in which chemotherapy for childhood cancer was developed. If physicians had all treated their cancer patients individually, without collaborating in collecting data and analyzing their results, they would not have learned how to best treat the disease. In the same way, we will be capturing data as part of a large clinical trial, and following patients long-term."

This multidisciplinary program for weight management includes experts in pediatric gastroenterology, endocrinology, nutrition, psychiatry, diabetes, surgery, and other specialties. As one of the leading centers in a multi-center trial sponsored by the American Pediatric Surgical Association, the pediatric obesity program is part of a consortium of major children's hospitals conducting careful study of bariatric surgery in adolescents. Because the program includes physicians with long expertise in each specialty, patients can be assured that they are receiving the highest level of care available.

For information about the pediatric obesity program, please call 212.305.8862.

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