Teenagers who are severely obese and who undergo bariatric surgery have abundant comorbidities, but the rate and types of complications in the early postoperative period are similar to those in their adult counterparts, researchers report.

These findings, from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, provide insights into the metabolic characteristics of these very overweight teenagers and reassurance about safety surrounding this surgery in this age group, according to the authors.

"These folks who are currently seeking bariatric surgery in teenage years are...on average, 3 times what would be considered a healthy weight for their age, [and] they have developed adult-like health problems," lead author Thomas Inge, MD, from Cincinnati Children's Hospital Medical Center in Ohio, told Medscape Medical News.

"The other part of the equation is they are undergoing surgery that is, in general, very safe," he continued. More than 90% of the teenagers did not have major surgical complications, such as the need for repeat operation. The frequencies and types of surgical complications were similar to those in a high-volume adult center, which was "reassuring."

The study was published online November 4 in JAMA Pediatrics, and Dr. Inge will present the study at Obesity Week 2013: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting, held November 11 through 16 in Atlanta, Georgia.

Troubled Teenagers Seeking Aggressive Solution

An estimated 4% to 7% of teenagers are severely obese, but nonsurgical treatments rarely lead to substantial, sustained weight loss or improvements in cardiovascular risk factors. Meanwhile, the number of adolescents choosing weight-loss surgery tripled from the late 1990s to 2003. However, the comorbidities in this age group and the risks and benefits of this surgery have not been well-studied, Dr. Inge and colleagues write.

The Teen-LABS study was designed as an ancillary study to the adult LABS study to address these knowledge gaps. This report analyzed baseline clinical characteristics and 30-day complications in consecutive individuals younger than 19 years who were approved to undergo bariatric surgery at 5 Teen-LABS centers between 2007 and 2011.

Of 277 teenagers who were offered enrollment, 242 participated in the study. The teenagers had a mean age of 17.1 years; with the ages spread over 3 age groups (13 to 15 years, 26.9%; 16 to 17 years, 37.6%;, and 18 to 19 years, 35.5%). They had a median body mass index of 50.5 kg/m2, and about three quarters had a body mass index between 40 and 59 kg/m2.

They were much more likely than other teenagers to have cardiovascular risk factors. Whereas the prevalence of hypertension, high low-density lipoprotein cholesterol levels, and low high-density lipoprotein cholesterol levels in a national representative sample of teenagers is estimated as at 3%, 8%, and 3%, respectively, the prevalence in teens undergoing bariatric surgery may be as high as 45%, 8.5%, and 64%, respectively.

Just more than half had 4 or more comorbidities, most commonly dyslipidemia, sleep apnea, joint pain, and hypertension. In addition, an "unexpected, but concerning" finding was that 75% of participants had elevated C-reactive protein levels, and 19% had abnormal kidney function.

Most patients (66%) underwent laparoscopic Roux-en-Y gastric bypass, whereas 28% underwent vertical sleeve gastrectomy and 6% had adjustable gastric banding procedures. During the course of the study, there was an increase in the number of patients who underwent sleeve gastrectomy and a decrease in gastric banding.

There were no deaths during the initial hospitalization or within 30 days of operation. A total of 19 patients (8%) had major complications, such as reoperation,, and 36 patients (15%) had minor complications, such as readmission for dehydration.

In about 2 months, the cohort will have completed a 2-year follow-up, and data will be compared with that of LABS-2 in adults. "We're going to ask the question, 'does operating in teenage years make sense compared to the option of waiting to adulthood?' " Dr. Inge said.

Psychosocial Function as Important as Medical Indications

Other experts are awaiting those longer follow-up data as well, notes Michael G. Sarr, MD, from the Mayo Clinic, Rochester, Minnesota, in an accompanying editorial. "We all await the long-term results of this well-planned program of committed, longitudinal follow-up in terms of reversal of the direct weight-related morbidity in these children (ie, insulin resistance, dyslipidemia, hypertension, and sleep apnea — conditions that we as health care providers rarely saw 20 or 30 years ago)," he writes.

However, psychosocial function is an equally important outcome to study, he stresses. "Adolescence is a crucial time for the development of the emotional as well as social foundation of later life; many of us maintain that the psychosocial retardation (or call it politically whatever you want — handicap, isolation, impairment — we all know what this means) probably needs to be considered on equal terms, as are the more evident metabolic problems of severe obesity; they are all interrelated," Dr. Sarr concludes.

Dr. Inge takes exception to the term "psychosocial retardation," which is attributed to a surgeon who gave a lecture 7 years ago. This pejorative term would not be used today. However, it illustrates how these severely obese teenagers can be stigmatized by society and illuminates how some might derive motivation from name-calling and decide to undergo aggressive treatment to reclaim their health and their respect.

The Teen-LABS Consortium was funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health. Dr Inge has received research funding from Ethicon Endosurgery. Full conflict-of-interest information is available on the journal's Web site. Dr Sarr has disclosed no relevant financial relationships.

JAMA Pediatr. Published online November 4, 2013. Article full text, Editorial full text


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