Adolescents benefit from gastric bypass for obesity

Last Updated: 2019-05-20

By Will Boggs MD

NEW YORK (Reuters Health) - Adolescents who undergo gastric bypass for obesity experience weight loss similar to that of adults who undergo bariatric surgery, according to researchers who compared the results from two similar studies.

"Metabolic/bariatric surgery is considered mainstream treatment for severe obesity in adults," Dr. Thomas H. Inge from University of Colorado, Denver and Children's Hospital Colorado, Aurora, Colorado told Reuters Health by email. "However, in teenagers, there has been great reluctance to recommend surgery. I think this data adds to the collected research that shows surgery is a reasonable consideration for some adolescents. Indeed, it seems that in some ways, surgery offers even more advantage in teenagers than adults."

Dr. Inge and colleagues in the Teen-LABS Consortium examined outcomes of gastric bypass in 161 adolescents who participated in the Teen-LABS study and 396 adult participants in the LABS study who had a history of obesity dating back to adolescence.

Five years after surgery, the mean percent weight loss after surgery did not differ significantly between adolescents (26%) and adults (29%), according to the May 16th New England Journal of Medicine online report.

Among patients with diabetes at baseline, 86% of adolescents and 53% of adults no longer met the criterion for diabetes five years after surgery, which represents a 27% greater likelihood of diabetes remission among adolescents.

Similarly, among patients with hypertension at baseline, 68% of adolescents and 41% of adults were in remission five years after surgery, a 51% greater likelihood of remission in favor of adolescents.

Mortality in the first five years after surgery was low and did not differ between adolescents (1.9%) and adults (1.8%).

Adolescents underwent significantly more intra-abdominal procedures in the five years after surgery and at two years after surgery were significantly more likely to have low ferritin and 25-hydroxyvitamin D levels, compared with adults.

"In the past, teenagers were considered for surgery only long after they had achieved a weight that would be considered severely obese," Dr. Inge said. "Indeed, in my experience, teens are most commonly referred years after they developed severe obesity, often with BMI values above 50. I believe to have the best results we should be diagnosing severe obesity and determining what treatments are best for these teenagers much earlier. If we are more focused on earlier diagnosis and treatment, many complications of obesity could be prevented and surgery, when used, could be even safer."

Dr. Ted D. Adams from Intermountain Live Well Center and University of Utah, Salt Lake City, Utah, who wrote an editorial related to this report, told Reuters Health by email, "Like most medical interventions, there are risks and benefits related to adolescent bariatric surgery. Current and projected future health status (physiological and psychological) of the individual severely obese adolescent should be carefully considered as an integral component of the risk versus benefit evaluation."

In his editorial, he concludes that "more complete data will be required to fully inform clinicians, parents, and adolescents whether to embark on surgical intervention or to postpone it."

Dr. Jaime Ruiz-Tovar from Center of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain, who recently reported good five-year outcomes of obese children and adolescents who underwent gastric bypass, told Reuters Health by email, "Adolescents are physically and psychologically immature subjects. Thus, two aspects are essential for the success of the surgery: firstly, the adolescent must be sufficiently mature to understand the nature of bariatric surgery, its risk and consequences, and must assume that changes in eating behaviors and long-life follow-up are mandatory."

"On the other hand, the surgeon must be aware of the growing condition of the patient and must offer a technique that minimizes the risk of malnutrition," he said. "However, he must also consider that these patients have a long expectation of life and several bariatric approaches have shown long-term weight regain. Therefore, the indication of surgery and the selected technique must be individualized."

"Bariatric surgery is a good treatment option for morbidly obese adolescents with or without associated comorbidities," Dr. Ruiz-Tovar said. "Waiting up to adulthood results in longer evolution of comorbidities and results in lower remission rates after surgery. With a careful selection of patients and a customized indication of the technique, bariatric approaches can be a safe and effective treatment option among this population."

Dr. Torsten Olbers from Sahlgrenska University Hospital, University of Gothenburg, Sweden recently reported five-year outcomes of gastric bypass in adolescents with severe obesity there. He told Reuters Health by email, "On one hand, there has for a long time been concerns that surgery in young ages could lead to various developmental impairments and unforeseen long-term consequences. Most of these concerns have more or less been relieved in studies."

"On the other hand, there is a rising concern that not doing surgery will lead to further substantial weight gain and impairment of, for example, social and educational development," he said.

"In summary, it's about assessing the young person's severe obesity situation and realizing that now appears to be related to substantial worsening of the condition if not treated," Dr. Olbers said. "Thus, the table is turning and pediatricians need to justify why they didn't bring up bariatric/metabolic surgery in teenagers with severe obesity, especially if they have co-morbidities like type 2 diabetes, sleep apnea, or hypertension."

SOURCE: http://bit.ly/2HucEUX and http://bit.ly/2HtJpBN

N Engl J Med 2019.