Bariatric Surgery for Adolescents: 3 Year Follow-up Shows Good Results

For some of the 4.4 million American children and adolescents who are severely obese, bariatric surgery may be an option for weight reduction.

It’s an alternative that clinicians and patients have been increasingly willing to use, and surgical volumes doubled between 2003 and 2009. However, few researchers have gathered data or come to conclusions about its safety or long-term results in the adolescent population.

The January 2016 issue of the New England Journal of Medicine includes a study that covers many issues in the adolescent bariatric surgery patient: weight loss, coexisting conditions, weight-related quality of life, micronutrient levels, and additional abdominal procedures.

This prospective study enrolled 242 adolescents with a mean age of 17 years undergoing Roux-en-Y gastric bypass (n=161) or sleeve gastrectomy (n=67) at five geographically distinct American hospitals. Participants’ average body mass index was 53. The researchers evaluated patients periodically through three years.

At three years following the procedure, participants’ BMIs had decreased by an average of 27%, with the average weight loss similar regardless of whether the patient underwent gastric bypass or sleeve gastrectomy.

Almost all patients (95%) who had active type 2 diabetes before surgery were in remission by the third year. In addition, 86% of patients with abnormal kidney function at baseline experienced remission after surgery.

The researchers also documented improvements in blood pressure in 74% of participants and remission of dyslipidemia in 66%. Patients reported significant improvements in quality of life.

One interesting finding was a micronutrient deficiency — 57% of patients had developed hypoferritinemia at the three-year mark.

A total of 8% of the participants experienced major complications within 30 days of surgery. Also, 13% of participants had one or more additional intraabdominal procedures, with the majority of these surgeries performed in the second year after the primary surgery, indicating that these procedures are associated with some risks.