Two sides to bariatric surgery for teens

Three years after undergoing bariatric surgery, obese adolescents had lost significant weight and improved their cardiometabolic health and weight-related quality of life, according to a prospective study in 242 teenagers. However, some participants also developed micronutrient deficiencies during the 3-year period and needed additional abdominal procedures.

Of total participants, most (67%) underwent Roux-en-Y gastric bypass, with 28% having sleeve gastrectomy and 6% adjustable gastric banding. (Because so few participants had adjustable gastric banding, investigators did not include results for this group in their analysis.) The adolescents ranged in age from 13 to 19 years and had a mean body mass index (BMI) of 53 before the procedure; 98% had a BMI higher than 40. After collecting baseline data for all participants, investigators evaluated changes in body weight, coexisting conditions, and other data periodically for 3 years after the procedure.

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At 3 years postsurgery, 26% of participants were no longer obese. Participants overall had a mean weight loss of 27%; for participants who underwent gastric bypass this figure was 28%, and for those who had sleeve gastrectomy, 26%. Among participants who underwent gastric bypass, 89% had at least a 10% reduction in BMI; for sleeve gastrectomy this figure was 85%. At the end of the study, only 2% of participants who underwent gastric bypass and 4% of those who had sleeve gastrectomy weighed more than they had at baseline.

Surgery also led to related health improvements, with remission of several comorbidities in those who had these conditions at baseline: remission of type 2 diabetes in 95%; abnormal kidney function in 86%; prediabetes in 76%; elevated blood pressure in 74%; and dyslipidemia in 66%. Weight-related quality of life also improved significantly, as assessed by the Impact of Weight on Quality of Life-Kids instrument, which measures how weight affects a youngster’s physical comfort, body esteem, social life, and family relations.

On the negative side, 57% of participants had low ferritin levels at 3 years postsurgery compared with 5% at baseline. The proportion of participants with deficiencies of vitamin B12 or vitamin A also increased over time. In addition, 13% of participants underwent 1 or more additional intraabdominal procedures, all but 3 of which were related to the prior bariatric surgery (Inge TH, et al. N Engl J Med. 2016;374[2]:113-123).

Commentary: Surgical intervention as treatment for obesity is not for everyone. However, for this select group of severely obese teenagers, these interventions may be the best that we have to offer, and earlier may be better. Hypertension and diabetes mellitus resolved more often in these adolescents than in similar populations of obese adults who had bariatric surgery for longstanding obesity. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.