Gastric Bypass Surgery More Successful in Teens and Young Adults

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Adolescents and adults who have had gastric bypass surgery were able to maintain weight loss five years post-op, but for adolescents, the procedure more often reversed the course of diabetes and hypertension. The study appears in the May 30 issue of the New England Journal of Medicine.

The study is based on the results of two independent studies of adolescents and adults who have had gastric bypass surgerys. It included 161 adolescents who had the procedure between 2006 and 2012 and 396 adults who had the same procedure between 2006 and 2009.

Adolescents experienced on average a 26 percent weight loss over five years as compared to 29 percent of adults. And, 86 percent of adlosecents experienced remission of type 2 diabetes as compared to 53 percent of adults. In terms of hypertension, 68 percent of adolesecents went into remission as compared to 42 percent of adults.

But the procedures were not without risk. Follow-up abdominal surgeries were necessary in 19 adolescents and 10 adults (per 500 person years). And, 72 of 132 adolecents reported low ferritin levels as compared to 54 of 179 patients suggesting that this group is not adhering to vitamin and mineral supplementation regimens.

"Clinical practice guidelines should highlight the vulnerability of adolescents to micronutrient deficiencies after gastric bypass; patients and health care providers should consider strategies to minimize menstrual blood loss, in addition to recognizing the need for lifelong micronutrient supplementation and monitoring for adverse effects including anemia, neurologic effects, and osteoporosis," wrote the authors who were led by Thomas H. Inge, M.D., Ph.D., of Children’s Hospital Colorado.

Five years post-op, there were three deaths among adolescent patients and seven deaths among adult patients. Two of the adolescent deaths were related to substance abuse of more than one drug.

"Although previous long-term analyses showed substantially decreased cardiovascular10 and all-cause11 mortality among adults who underwent gastric bypass, evidence has also highlighted concerns about increased risks of death from accidental causes, suicide, and poisoning," the authors wrote.

REFERENCE

Thomas H. Inge, M.D., Ph.D., Anita P. Courcoulas, M.D., Todd M. Jenkins, Ph.D., et al. "Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults," New England Journal of Medicine. May 30, 2019; 380:2136-2145; DOI: 10.1056/NEJMoa1813909