10-Year Follow-Up Shows Lasting Benefits of Bariatric Surgery for Teens with Severe Obesity

Thomas Inge, MD, PhD

Credit: Ann & Robert H. Lurie Children's Hospital of Chicago

A recent study reported that 10 years after teens underwent bariatric surgery as teens, more than half of the participants achieved sustained weight loss and elimination of obesity-related conditions such as type 2 diabetes, hypertension, and high cholesterol.¹

“Our study presents impressive outcomes of the longest follow-up of weight loss surgery during adolescence, which validates bariatric surgery as a safe and effective long-term obesity management strategy,” said lead author Justin Ryder, PhD, vice chair of research for the department of surgery at Ann & Robert H. Lurie Children's Hospital of Chicago.²

This was a follow-up study of Teen Longitudinal Assessment of Bariatric Surgery (Teen LABS), a prospective multicenter observational cohort study supported by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.³ This study, conducted from 2006 to 2012, examined the short- and long-term risks and benefits of bariatric surgery in 240 teens (aged 13 – 19 years), including gastric band, gastric sleeve, and gastric bypass. Participants were teens who had severe obesity and serious weight-related health issues, such as prediabetes, type 2 diabetes, cardiovascular disease, sleep apnea, nonalcoholic fatty liver disease, or other conditions.

The original trial discovered teens had major improvements in weight, heart health, prediabetes, type 2 diabetes, hypertension, high blood cholesterol, and abnormal kidney function 3 years after bariatric surgery. Five years after the weight-loss surgery, the team compared teens who had gastric bypass surgery with adults who had the same procedure. They discovered that having gastric bypass surgery earlier may have greater benefits than waiting until they are older.

Teenagers lost 26% of their bodyweight, whereas adults lost 29%. Before surgery, 88% of teens needed diabetes medications, and no teens needed them afterward. However, for adults, 79% needed diabetes medications before surgery, and 26% still needed them afterward.

Furthermore, teens were more likely than adults to no longer have hypertension. While 57% of teens needed hypertension medications before surgery, 11% needed it after surgery. Likewise, 68% of adults needed hypertension before surgery and 33% needed it after surgery.

In this 10-year follow-up study, results were comparable to earlier findings. After 10 years, participants sustained a mean reduction of 20% in body mass index (BMI) (95% confidence interval [CI], - 22.9 to -17.1; P < .001).¹ The analysis revealed that greater early weight loss, measured as the change in BMI at 6 months, was linked to a more favorable long-term BMI trajectory (odds ratio [OR], 1.16; 95% CI, 1.11 to 1.21).

Additionally, after 10 years, participants had a sustained mean reduction of 55% in type 2 diabetes (95% CI, 35 to 75), 57% in hypertension (95% CI, 39 to 75), and 54% in abnormal cholesterol (95% CI, 42 to 66). The reductions of BMI, diabetes, hypertension, and cholesterol were similar among participants undergoing gastric bypass (mean change, −20.6%; 95% CI, −24.8 to −16.4) and sleeve gastrectomy (mean change, −19.2%; 95% CI, −24.8 to −13.5).

The team saw teens who had undergone surgery had a greater reduction of type 2 diabetes (55%) than adults post weight-loss surgery (18% at 7 years and 12.7% at 12 years). The follow-up results revealed type 2 diabetes tends to progress more rapidly in young individuals, and thus teens often receive greater health benefits from bariatric surgery compared with adults.

Despite this, bariatric surgery is under-utilized, with only 1 out of every 25000 teens with severe obesity undergoing the procedure.

“The fascinating part is that when we use these operations in teenagers, the remission of health conditions like diabetes and high blood pressure are more durable than when operations are done later in adulthood,” said lead investigator Thomas Inge, MD, PhD, Surgeon-in-Chief at Lurie Children’s.²

References

1. ^{Ryder, J, Jenkins, T, Xie, C, et al. Ten-Year Outcomes after Bariatric Surgery in Adolescents. The New England Journal of Medicine. 2024. DOI: 10.1056/NEJMc2404054}
2. ^{Sustained remission of diabetes and other obesity-related conditions found a decade after weight loss surgery in adolescence. EurekAlert! October 30, 2024. https://www.eurekalert.org/news-releases/1062875?. Accessed October 30, 2024.}
3. ^{Bariatric Surgery for Teens with Severe Obesity Study: Teen-LABS. National Institute of Diabetes and Digestive and Kidney Diseases. May 2023. https://www.niddk.nih.gov/about-niddk/research-areas/obesity/bariatric-surgery-teens-severe-obesity-study-teen-labs. Accessed October 30, 2024.}