Weight Loss Surgery for Teens: Ready for Prime Time?

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

Inge TH, Courcoulas AP, Jenkins TM, et al; Teen-LABS Consortium
N Engl J Med. 2016;374:113-123

Study Summary

This longitudinal study provides clinical and laboratory data on teenagers who received bariatric surgery at one of five US medical centers. The study focused on weight loss and its effect on comorbid conditions, quality of life, and micronutrient levels and assessed the need for additional abdominal procedures among the teens.

Teen participants were aged 19 years or younger at the time of surgery, which took place between March 2007 and February 2012. All teens were followed for 3 years after surgery. In-person evaluations were conducted at 6 months and at 1, 2, and 3 years after the operative procedure. At the in-person evaluations, teens completed a standard instrument to evaluate quality of life and report any additional procedures.

This analysis included 242 teens (average age, 17 years), 67% of whom had the Roux-en-Y gastric bypass and 28% of whom had a sleeve gastrectomy. The remaining 6% of study teens received an adjustable gastric band and were not included in the outcomes report because of the small number of participants.

At the time of the procedure, the mean body mass index of the teens was 53 kg/m², with 98% having a body mass index > 40 kg/m². Approximately 88% of all postoperative visits were completed.

A marked improvement was seen in obesity-related conditions in the cohort during the 3-year follow-up period. Initially, the prevalence of type 2 diabetes was 13%, but there was a 90% reduction in the prevalence of type 2 diabetes by year 3. Similarly, there was a 76% reduction in the prevalence of prediabetes, a 66% reduction in the prevalence of dyslipidemia, a 74% reduction in elevated blood pressure, and an 86% reduction in abnormal kidney function.

Overall, the average weight loss among the participants was 41 kg (27%) at the end of the 3-year follow-up period. Mean quality-of-life scores improved approximately 33% between baseline and the end of follow-up.

With respect to micronutrient levels, ferritin insufficiency was observed in 5% of the cohort at baseline and in 57% at follow-up. Vitamin B levels and vitamin A levels declined in the period after the procedure.

Approximately 13% of the teens required additional intra-abdominal operations. The types of follow-up procedures included ventral hernia repairs, exploratory laparotomies, and lysis of adhesions, among others. Cholecystectomy was required in 8% of the teens, 9% required upper-tract endoscopy, and 4% required dilation of a stricture.

The investigators concluded that the teens in the study experienced significant improvement in weight, cardiovascular comorbidities, and weight-related quality of life in the 3 years of follow-up after their procedures. A significant proportion experienced micronutrient deficiencies, and many required additional abdominal procedures.

Viewpoint

I will never forget the first time at a national meeting that I went to a session discussing bariatric surgery for adolescents. I remember asking myself, "Is this really what we've come to?"

In the years since, however, my thoughts about bariatric surgery for adolescents have evolved. We have all cared for patients who, despite what we feel have been appropriate efforts, continue to gain weight and begin to develop compounding comorbid conditions that further exacerbate their ability to manage their weight. For a very selected number of these patients, gastric bypass has been one of the few interventions that has produced clinical benefits.

This study is very important for demonstrating several things, including the durability of the benefit, reductions in comorbid conditions that everyone would agree are clinically significant, and improvement in quality-of-life measures. The challenge for providers is to better identify the patients who are appropriate for bariatric procedures.

Abstract

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