Bariatric Surgery in Adolescents

According to published data, severe obesity affects about 4.5 million children and adolescents in the United States, and another 22 million are classified as being overweight.

With few effective treatments available for this patient population, there has been a recent emergence in the use of bariatric surgery in adolescents. “Severe pediatric obesity is fast becoming a public health crisis because these patients are likely to develop significant health problems later in life,” says Thomas H. Inge, MD, PhD, FACS, FAAP.

Assessing Outcomes

Most obesity treatment approaches are not successful for obese children, and this is particularly true for severely obese kids. Bariatric surgery has been used in teenagers for several decades but few prospective studies have examined changes in BMI and outcomes of modern bariatric procedures. Thus families and primary care providers have little hard evidence about clinical outcomes and risks after bariatric surgery in adolescents.

To address this issue, Dr. Inge and colleagues recently published study findings in the New England Journal of Medicine that explored the efficacy and safety of bariatric surgery in adolescents. For the analysis, the authors used data from the Teen-Longitudinal Assessment of Bariatric Surgery study, which collects longitudinal prospective clinical and laboratory information on teenagers undergoing bariatric surgery at five centers in the United States.

The investigators prospectively examined 242 adolescents undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67 participants) in the analysis. They then examined changes in body weight, coexisting conditions, cardiometabolic risk factors, weight-related quality of life (QOL), and postoperative complications through 3 years after the procedure. Patients in the analysis were between the ages of 13 and 19 and their average BMI before surgery was quite high at 53 kg/m².

Marked Improvements

When assessed at 3 years after the procedure, the average weight of patients decreased by 27% in the total cohort (28% for gastric bypass recipients and 26% for those undergoing sleeve gastrectomy). “Almost all adolescents—95%—who had type 2 diabetes and underwent bariatric surgery had remission of their disease at the conclusion of the study,” says Dr. Inge. “In addition, their weight-related QOL also improved significantly.”

Below is a summary of remission of obesity related-health conditions among adolescents when assessed at 3 years after surgery:

• Type 2 diabetes: 95% in remission.
• Abnormal kidney function: 86% in remission.
• Prediabetes: 76% in remission.
• Elevated blood pressure: 74% in remission.
• Dyslipidemia: 66% in remission.

“The rates of remission of dyslipidemia and high blood pressure were substantially higher than that expected for adults undergoing these procedures,” Dr. Inge adds.

Although the authors observed some risks for adolescents who underwent bariatric surgery, Dr. Inge says the procedure was relatively safe. “Few patients required additional major surgeries after their bariatric operation,” he says. The results highlight the importance of long-term follow-up and making efforts to ensure that appropriate supplementation is provided to minimize risks for clinically significant nutritional deficiencies.

More to Come

The pros and cons of bariatric procedures must be weighed in the context of other potential risks, but Dr. Inge says clinicians should view the findings as a wake-up call to be more proactive in the fight against severe obesity among teenagers. “We need to monitor these patients and consider recommending bariatric surgery to them earlier in life in order to have a positive effect on the downstream consequences of obesity,” he says.

While 3 years is a good start, longer-term study is needed so that clinicians and families can feel that they are most informed about the risk of postoperative complications. The study investigators would like to continue to follow and report outcomes from this entire cohort for a full decade and beyond. Physicians can achieve a better understanding of the role of bariatric surgery for treating severe obesity in adolescents by assessing the longer-term durability of weight loss, potential improvements in coexisting conditions, and risks for adverse events.