Release Date: November 11, 2015
BUFFALO, N.Y. — The first national study of severely obese teenagers after weight-loss surgery, published this month in the New England Journal of Medicine (NEJM), was co-authored by a physician-scientist and faculty member with a joint appointment at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo and Women & Children’s Hospital of Buffalo (WCHOB).
In 2014, Carroll McWilliams Harmon, MD, PhD, was recruited to UB as John E. Fisher Chair in Pediatric Surgery, chief of pediatric surgery and program director of the pediatric surgery fellowship, and to WCHOB as pediatric surgeon-in-chief. He sees patients through UBMD Pediatric Surgery.
He came from the University of Alabama at Birmingham School of Medicine, which is where he conducted the multicenter clinical trial on teen weight-loss surgery. As principal investigator on the $10 million National Institutes of Health study, he has been leading the first national effort to assess the short- and longer-term safety and efficacy of bariatric surgery in adolescents.
Government statistics estimate that about 18 percent of children and adolescents in the U.S. are obese. Harmon stressed that the benefits of bariatric surgery are relevant to this specific population of teens and that the incidence of extreme obesity varies geographically.
“Southern states like Mississippi and Alabama always rank high,” he says. “New York as a state is not too bad, but in Western New York it’s a significant problem.”
A report issued last week, based on New York State Department of Health data, stated that 32 percent of children in Erie County are obese or overweight, up 4 percent from 2012.
Last December, Harmon launched Children’s Healthy Weigh of Buffalo (CHWOB) at WCHOB, Western New York’s first comprehensive weight-reduction program for children and adolescents. The first patient was a 13-year-old who weighed 530 pounds.
He notes that the program, which is rapidly growing, brings an important, multidisciplinary approach to these patients, a boon not just to the patients and their families but also to local primary care physicians.
“Pediatricians struggle with these patients,” Harmon said. “These kids all have complications: obstructive sleep apnea, hypertension, Type 2 diabetes.” And while those are the same issues that occur in obese adults, he noted that teen patients require a different approach. In order for the surgery to be successful, patients need to have frequent follow-up appointments with the program team and remain compliant in terms of how they eat and when.
“That can be challenging,” Harmon said, smiling, “because it goes against being a teen.”
The NEJM results show significant improvements three years after weight-loss surgery in patients’ weight, cardiovascular and metabolic health, and quality of life markers related to weight. Patients saw an average weight loss of 27 percent – at least 100 pounds in most cases -- and 95 percent saw remission of Type 2 diabetes, 86 percent had abnormal kidney function return to normal and 74 percent had remission of hypertension. Of the 242 patients, 75 percent were female, mostly aged 15–18 with an average body-mass index of 53, indicating extreme obesity.
Harmon is excited about the collaboration between his clinical work on obesity at WCHOB and his research into the basic science of fat, which he is conducting at UB’s Clinical and Translational Research Center downtown. He is developing a biorepository of tissue and blood specimens to get a better understanding of how fat forms and why.
Harmon brought with him to Buffalo two researchers who are studying mutations in brain receptors that regulate appetite, which are implicated in a subset of obese patients. Pharmaceutical companies have expressed interest in this work because of the potential for developing a drug that could fix the broken receptor.
With the 2017 opening of the John R. Oishei Children’s Hospital and the new building for the Jacobs School of Medicine and Biomedical Sciences at UB, Harmon is looking forward to expanding the current CHWOB program to include a family-based weight reduction program that would treat the entire family.