Bariatric Surgery As Effective in Younger Teens as Older Teens, Study Finds

Thomas Inge, MD

New research from the Children’s Hospital of Colorado is shedding light on the effectiveness of weight loss surgery among teenaged patients according to age.

The study, which compared outcomes following bariatric surgery among teens 13-15 versus those 16-19 years old, indicates similar outcomes following surgery—leading investigators to suggest age alone should not immediately rule out surgery as an option when medically indicated.

"Younger teens have less commonly been considered eligible for surgery due to their age, but the findings in this analysis should shift the focus from a concern about age to more important factors that should drive decision-making. These include providing the patient with the best opportunity to reach a normal BMI after surgery, reversal of serious complications of obesity, and treatment that will most likely increase the lifespan," said Thomas H. Inge, MD, PhD, director of pediatric surgery and the bariatric center at Children's Colorado in a statement.

To further investigate how age impacts outcomes following bariatric surgery, Inge and a team of colleagues designed the current study as an analysis of data from the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. A prospective observational study patients 19 years of age or younger from 5 clinical centers in the US who underwent metabolic surgery between 2007 and 2012, Teen-LABS provided investigators with data related to 242 patients.

Of the 242 patients included in Teen-LABS, 228 were included in the current study. Of note, the 14 patients excluded by investigators all underwent laparoscopic adjustable gastric banding were excluded because such a small number underwent that procedure. As such, only those who underwent Roux-en-Y gastric bypass (n=161) or vertical sleeve gastrectomy (n=67) were included in the final analyses.

For the purpose of analysis, investigators divided patients into 2 age groups based on age at time of surgery. Overall, 66 patients were included in the 13-15-year-old group and 162 were included in the 16-19-year-old group. The full study cohort was 75% female, 72% were white, and the mean baseline BMI was 52.6 kg/m2. The mean age at time of surgery among those in the younger cohort was 15.1±0.8 years and the average BMI was 53.1±11.1 kg/m2. The mean age at time of surgery among those in the older cohort was 17±1 years and the average BMI was 52.4±9 kg/m2.

The primary outcomes for the investigators’ analyses included percent BMI change, comorbidity outcomes, nutritional abnormalities, and quality of life over 5 years post-surgery. Investigators identified hypertension, dyslipidemia, and type 2 diabetes as comorbidities of interest.

When comparing outcomes at 5 years, adjusted analyses indicated there were no significant differences in frequency of remission of hypertension, or dyslipidemia between the age groups. Results suggested remission of type 2 diabetes was greater among older patients (RR, 0.86; P=.046), but investigators pointed out rates of remission were high among both groups. Additionally, weight loss and quality of life were also similar between the age groups. Investigators noted younger patients were less likely to develop elevated transferrin (prevalence ratio: 0.52; P=.048) and low vitamin D levels (prevalence ratio: 0.8; P=.034) compared to those in the older group.

While investigators noted these results support use of bariatric surgery in younger teen patients, further investigation is needed to develop a more complete understanding of bariatric surgery in younger populations.

"While these results are promising, longer term study of this early intervention is needed to fully evaluate the impact of surgery to reverse late effects of childhood severe obesity that develop over the decades,” added Inge, who is also a Teen-LABS principal investigator, in the aforementioned statement.

This study, “Outcomes of Bariatric Surgery in Older Versus Younger Adolescents,” was published in Pediatrics.