Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents

Abstract

Background
Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making.


Methods
We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure.


Results
The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures.


Conclusion
In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micronutrient deficiencies and the need for additional abdominal procedures. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; Teen-LABS ClinicalTrials.gov number, NCT00474318.)

Severe obesity affects 4.4 million children and adolescents in the United States,1 and few effective treatments are available.2 Particular concern has centered on health problems among severely obese adolescents and possible treatment with bariatric surgery.3 Indeed, adolescent bariatric surgical case volumes doubled from approximately 800 cases in 20034 to 1600 procedures in 2009.5 Few prospective studies have examined changes in body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) and outcomes of the currently used surgical procedures, and little is known about clinical events after bariatric surgery in adolescents.6,7

To address important questions regarding the efficacy and safety of bariatric surgery in adolescents, the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study collects longitudinal, prospective clinical and laboratory data on teenagers undergoing bariatric surgery at five centers in the United States. The current report presents data on weight loss, coexisting conditions, weight-related quality of life, micronutrient levels, and additional abdominal procedures during the 3 years after the bariatric procedure.