All adolescents who are candidates for gastric band surgery will be required to undergo the following evaluations.
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Assessment by Specialist Bariatric Physician - This preliminary consultation is to establish eligibility, to discuss the gastric band procedure in detail and to carry out an initial physical examination. If the patient is suitable he/she will be referred to the next specialist.
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Assessment by Consultant Paediatric Endocrinologist - The purpose of this is to obtain an independent expert view on the patient’s history, physical, social and psychological development. It will include an interview with parents and may also include an interview with the teenager without the parents being present.
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Blood investigations- Routine blood tests will be carried out to establish current health status and to exclude underlying metabolic, endocrine (hormonal) or (where necessary) genetic factors
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A 4-week weight loss programme - Teenagers who are surgical candidates will be required to engage in a 4-week weight loss programme prior to surgery. It may seem strange to some that a requirement for surgery is that the young person should be able to lose weight by diet and physical activity alone. After all, if they were able to do that consistently, they wouldn’t need surgery. However, there are a number of important reasons to insist on this:
- Firstly, we know that patients who lose weight almost always put it back as soon as dieting ends. In the case of the adolescent, it is not a requirement that they maintain their weight loss, only that they are able to lose 5% of their baseline weight over a 4 week period. This tests their ability to adhere to a variety of behaviours (eating smaller portions, keeping a food and activity diary etc) which will be essential to long-term success once the band is implanted. Those who are unable to commit to this are unlikely to succeed with the gastric band and will not be allowed to proceed to surgery. Incidentally, a 5% loss of baseline weight over 4 weeks is a modest target which should not prove too onerous for the majority of adolescents eligible for gastric band surgery.
- The 4 week pre-operative programme also gives time for us to observe the young person and his/her ability to participate fully in the preparation process. This includes regular communication with the Healthier Weight medical team (text; e-mail, telephone), self-monitoring (food and activity diary) and regular physical activity.
- Another important benefit of pre-operative weight loss is that it reduces the (already very low) risk of surgery even more. Weight loss improves a variety of physical measures (blood pressure, blood sugar etc) and also reduces the size of the liver. The latter is important because this makes surgery easier, especially for those who have type 2 diabetes.
- Finally, we know from adult studies that pre-operative weight loss may improve long-term outcomes after implantation of the gastric band. Whilst no such studies have been carried out in adolescents, it seems at least plausible that a similar benefit would be seen in younger people
