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Benefits of Bariatric Surgery in Adolescents Endure Beyond a Decade, Study Shows

Data from a study led by investigators from the University of Texas and the University of Miami is providing insight into the effects of bariatric surgery on long-term body weight and risk of comorbidities in adolescent populations with severe obesity.

An analysis of data from nearly 100 patients who underwent metabolic and bariatric surgery at 21 years of age or younger, results of the study suggest undergoing such a procedure was associated with a mean reduction in body weight of 31.3% more than a decade after undergoing surgery, with results indicating undergoing surgery was also associated with long-term remission of diabetes.

“There are long-term benefits to completing bariatric surgery before the age of 22,” said Sarah Messiah, PhD, MPH, senior author of the study and professor and director of the Center for Pediatric Population Health at UTHealth School of Public Health-Dallas, in a statement. “The durability of the positive health outcomes isn’t well known this far out at this young age. It’s been a gap in understanding that this research has helped fill.”

As the obesity epidemic has ballooned, so has the popularity and knowledge base surrounding bariatric surgery as a potential treatment for obesity. In more recent years, bariatric surgery among adolescent populations has begun to increase as the safety of procedures has become more well-established. However, as investigators of the current study note, fewer research efforts have been undertaken to examine the long-term impact of metabolic and bariatric surgeries beyond 10 years of follow-up in adolescent populations.

With this in mind, Messiah and colleagues designed the current study as an analysis of long-term outcomes after bariatric surgery in patients aged 15-21 years before surgery and with a minimum of 10-18 years of follow-up from a single academic medical center. In total, 96 individuals who underwent surgery between 2002-2010 were identified for inclusion in the investigators’ analyses. Before surgery, this cohort had a mean age of 18.7±1.6 years, a median BMI of 45.0 kg/m2, and 83% were female. Investigators also pointed out 5.2% had type 2 diabetes, 13.5% had hypertension, and 14.6% had hyperlipidemia.

The majority of patients (90.6%) underwent gastric bypass while 9.4% underwent laparoscopic adjustable gastric banding )LAGB, and 1.0% underwent sleeve gastrectomy. The mean follow-up time of participants was 14.2±2.2 years. Upon analysis, results indicated the mean total decrease in body weight among adolescents who had undergone bariatric surgery was 31.3% (IQR, 20.0-38.9%), with body weight reductions of 32.0% (IQR, 21.3-40.1%) observed among RYGB participants and 22.5% (IQR, 0.64-28.3%) among LAGB participants.

Further analysis suggested individuals with hyperlipidemia, and diabetes or hyperglycemia before surgery reported 100% remission at follow-up (P <.05). Investigators also pointed out decreases in the prevalence of multiple comorbidities was decreased at baseline compared to before surgery, including hypertension (13.5% vs 1%; P=.001), sleep apnea (16.7% vs 1.0%; P <.001), gastroesophageal reflux disease (13.5% vs 3.1%; P=.016), anxiety (7.3% vs 2.1%; P=.169), and depression (27.1% vs 4.2%, P <.001).

“Adolescents are the fastest-growing segment of the severe obesity epidemic in the US, and the COVID-19 pandemic has exacerbated the problem,” Messiah added. “The evidence from this study supports recent recommendations from the American Academy of Pediatrics to increase access to surgery for adolescents. We hope this data could change barriers to access for these children.”

This study, "Long-Term Outcomes after Adolescent Bariatric Surgery,” was published in the Journal of the American College of Surgeons.