Bariatric Surgery for Obese Adolescents

Study Questions:

Is bariatric surgery efficacious and safe for adolescents with severe obesity?

Methods:

Adolescents undergoing weight-loss surgery at five US centers were prospectively enrolled in this cohort. Participants were 19 years of age or younger who were undergoing bariatric surgery between March 2007 and February 2012 at one of the participating centers. Both Roux-en-Y gastric bypass and sleeve gastrectomy procedures were included. Follow-up lasted for 3 years after surgery. Outcomes collected included changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications.

Results:

A total of 242 adolescents were included in this study, of which 161 participants underwent a Roux-en-Y gastric bypass and 67 participants underwent a sleeve gastrectomy. The mean age at baseline was 17 ± 1.6 years, and the mean body mass index was 53 kg/m2. The majority of the cohort was female (75%) and white (72%). At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25-29) in the total cohort. For those who underwent gastric bypass, mean weight decreased by 28% (95% CI, 25-30), and for those who underwent sleeve gastrectomy, mean weight decreased by 26% (95% CI, 22-30). Significant improvements in metabolic conditions were observed including remission of type 2 diabetes in 95% of participants who were diabetic at baseline (95% CI, 85-100) and remission of prediabetes in 76% of participants (95% CI, 56-97). Significant improvements were also observed in kidney function, blood pressure, and dyslipidemia. Weight-related quality of life also improved significantly. In terms of adverse effects, at 3 years, hypoferritinemia was found in 57% (95% CI, 50-65) of the participants, and 13% (95% CI, 9-18) of the participants had undergone one or more additional intra-abdominal procedures.

Conclusions:

The investigators concluded that among adolescents undergoing bariatric surgery, these data suggest significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure.

Perspective:

These data suggest that bariatric surgery for severely obese adolescents can improve weight loss, cardiometabolic parameters, and quality of life, yet patients and their families need to be aware of the potential for adverse events including further surgical procedures.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement

Keywords: Adolescent, Bariatric Surgery, Blood Pressure, Dyslipidemias, Gastrectomy, Gastric Bypass, Metabolic Syndrome X, Obesity, Obesity, Morbid, Postoperative Complications, Primary Prevention, Quality of Life, Risk Factors, Weight Loss


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