1. Adolescent Obesity - A Pediatric Surgeon’s Perspective Allen F. Browne, M.D. Adolescent Adjustable Gastric Band Interest Group AAGBIG

2. AAGBIG  IDE holders – 3  Interested Pediatric Centers - 11

3. “Givens”  Morbidly obese children are sick  Dismal prognosis if not successfully treated  Need help now

4. Bariatric Treatment  Nutrition  Behavior management  Activity  Pharmacology  Surgery  A multidisciplinary approach works

5. Current “Gold Standards”  80% response rate  Lose 60% of Excess Weight  Maintain response 5 yrs  Resolve comorbidities  Prevent comorbidities

6. What Works – What Doesn’t Work  FDA – 1993 Before AGB Before laparoscopy Before recent results  ADA - 2005

7. Questions  When should morbidly obese children be treated?  How risky is treatment?  How risky is non-treatment?

8. Comorbidities  Medical  Psychological  Social  Economic  When do they start?  When do they get harder to treat?  Can they be prevented

9. Adjustable Gastric Band  Not a Roux-Y-Gastric Bypass  Not a Bilio-pancreatic Diversion  Not a Sleeve resection  Unique FDA influence

10. Adjustable Gastric Band  Not an intragastric balloon  Not a gastric pacer

11. Adjustable Gastric Band  Removable  Adjustable  Lowest morbidity and mortality  It works

12. The AGB works  Australian government analysis  Recent U.S. data: Ponce – 2005 Ponce – 2005 Parikh, Fielding and Ren – 2005 Parikh, Fielding and Ren – 2005 Ren, Weiner and Allen – 2004 Ren, Weiner and Allen – 2004 Ren, Horgan and Ponce – 2002 Ren, Horgan and Ponce – 2002  Lessons from the A and B Studies

13. The AGB works in Adolescents  Small numbers, short term data Fielding Fielding Dixon Dixon Horgan, Holterman, Browne Horgan, Holterman, Browne

14. Recommendations - 1  Facilitate national demonstration AGB plus a comprehensive weight management program AGB plus a comprehensive weight management program  Facilitate IDE’s Common evaluation and management protocols Common evaluation and management protocols Shared data Shared data

15. Recommendations - 2  Begin with ages 13-17 years old  Use NIH guidelines  Follow patients at least 5 years  Use as endpoints: % EWL % EWL Resolution of co-morbidities Resolution of co-morbidities Development of co-morbidities Development of co-morbidities

16. Recommendations - 3  There is no place for randomized study of surgical procedures  There is no place for randomized study of surgical procedures vs. programs without surgical procedures.

17.  Thank You.