Bariatric surgery for teens goes beyond weight loss
Dr. Anita Courcoulas has looked into the health benefits of bariatric surgery for adolescent patients. The surgery put type 2 diabetes into remission for 10 of 11 patients studied and improved cholesterol and high blood pressure rates.
After Courtney Mike-Wilson, 21, of Clairton had bariatric surgery, she found her risk for type 2 diabetes was reduced.
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Courtney Mike-Wilson, of Clairton, did more than lose 136 pounds after undergoing gastric bypass surgery on Oct. 26, 2006 at the age of 18. She also got healthier.
Her pre-arthritic joints improved; a pre-type 2 diabetes mellitus condition called insulin resistance and her hypothyroidism went away; and she was able to go off medication for polycystic ovary syndrome, a malady in which women develop large ovarian cysts and have difficulty ovulating.
None of that surprises her surgeon, Dr. Anita Courcoulas, director of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center.
She was the UPMC author of a small, five medical-center study, or case series, published in the January issue of Pediatrics, that showed 10 of 11 extremely obese teenagers who underwent Roux-en-Y bypass surgery experienced remission of their type 2 diabetes along with improvements in other well-known risk factors for cardiovascular disease.
There were no such improvements in the control group, 67 patients with type 2 diabetes, all at the University of Cincinnati, who were treated medically but had no surgery.
It was the first such study of younger bariatric surgery patients, though there is much research available on adults.
"All but one of the 11 ... were able to go off insulin," Dr. Courcoulas said. "There were significant improvements in weight change. The improvement in diabetes was dramatic; cholesterol levels and blood pressure -- all four significantly improved compared to the control group."
Only two of the 11 were UPMC patients; Ms. Mike-Wilson was ineligible for the study because she did not have full-blown type 2 diabetes, but the positive outcome of her surgery mirrors that of the 10 who participated successfully.
The results of the case series enabled Dr. Courcoulas' research group at UPMC's Magee-Womens Hospital and researchers from the universities of Cincinnati and Alabama-Birmingham; and Texas Children's Hospital to get funding from the National Institutes of Health for a much larger, more comprehensive study that will assess the risks and benefits of gastric bypass surgery on adolescents.
A total of 200 patients are being enrolled and followed for five years beginning with their surgery. The enrollment actually began two years ago, and just over 60 patients, 15 from UPMC, already are participating. Again, Ms. Mike-Wilson wasn't eligible because the study wasn't enrolling at the time of her surgery.
"This will be a very definitive study that will assess the risks and benefits of the surgery," Dr. Courcoulas said. "We're looking at a wide variety of [factors], health improvements, quality of life."
There is, she added, "slightly greater than 1 percent chance of surgical complications, like bleeding, blood clots, infection, but we balance those small surgical risks against health improvements: dramatic weight change and some of these improvements in diabetes, high blood pressure and cholesterol."
And there are more benefits than the improvements listed above.
"This [small] study didn't look at them specifically, but we know of others in adults: [improvements] in sleep apnea, lower extremity leg swelling and blood clots, heartburn, polycystic ovary syndrome and infertility in women," Dr. Courcoulas said. "Those were not looked at in the 11 studied but will be in this group. ... as well also will be quality of life and psychosocial function, which is critical in young people whose life is just beginning to evolve ..."
Dr. Courcoulas believes those psychosocial improvements are just as important as the medical. Ms. Mike-Wilson believes that for her they're of even greater import.
Diagnosed as bipolar before she reached her teens, she spent most of her young life at the depressed end of that mental illness seesaw. "She was on different medications that made her gain weight," said her mother, Kim Mike-Wilson, an intensive care nurse from Penn Hills. "Then she started withdrawing, had poor self-esteem and started eating more." It became a vicious circle.
But now, Ms. Mike-Wilson is both happy and self-confident, making new friends, working for a temporary help agency while studying to finish high school and go on for training in medical coding.
"I'm more happy with my personality change and [improved] self-esteem than the health thing," said Ms. Mike-Wilson, now 21. "If I had continued on the path I was on, I would have ended up committing suicide or doing something stupid that would have caused my dying because I was so depressed and withdrawn from things."
Her mother concurs.
"I feel [Dr. Courcoulas] saved that child's life," Mrs. Mike-Wilson said. "If her health hadn't killed her; she would have committed suicide. She's a different person. She's off all her psychiatric medications; in fact, she's off all of her medications."
And that is the kind of story that Dr. Courcoulas says she and her colleagues like to hear best.
"Everybody focuses on the pounds and health risks improved ... but don't pay as much attention to how we impact people's quality of life," she said. "That's why we love what we do, because we feel we have an impact on people's lives."
First Published January 7, 2009 12:00 am