Bariatric Surgery in Teens: Do the Benefits Last?

Long-term Gains From Teen Bariatric Surgery

Improvements in measures of cardiovascular stamina and reductions in musculoskeletal pain have been well-characterized among adults who had bariatric surgery. In a recent study, Ryder and colleagues^[1] sought to evaluate similar outcomes among adolescents who had bariatric surgery at five US medical centers to determine whether adolescents with severe obesity who undergo bariatric surgery can realize the same benefits.

All teens were participants in a longitudinal observational study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. The adolescents (n=206) were assessed preoperatively and again at 6 months, 12 months, and 24 months after the procedure. The test of cardiovascular function was a 400-m walk test. Important measurements were the time to complete the walk, the resting heart rate before the walk, and the post-test heart rate. The investigators asked the teens about musculoskeletal pain and other symptoms during and after the walk, including knee, hip, calf, foot, or back pain; numbness; tingling; or leg cramps.

At the time of surgery, the mean age of the adolescents was 17.1 years. The mean body mass index (BMI) of the adolescents was 51.7 kg/m², with a range of 33.9 kg/m² to 80.4 kg/m². Slightly more than three fourths of the participants were girls, and the racial breakdown was 72.3% white, 21.4% black, 5.8% multiracial, and 0.5% Asian. The Roux-en-Y gastric bypass was the most common procedure (67.5%), followed by vertical sleeve gastrectomy (27.2%) and a laparoscopic adjustable gastric band (5.3%).

Adjusted improvements after bariatric surgery were found in the time to completion of the walking test and the resting heart rate. For example, the time to completion dropped from 378 seconds to 344 seconds. The mean resting heart rate went from 83 beats/min to 73 beats/min. The average post-test heart rate declined from a mean of 128 beats/min to 107 beats/min. The average heart rate 2 minutes after the walk also improved over time. Of note, most of the gain for each of the cardiovascular measures was during the first 12 months post-surgery, with very little change regardless of the measure between 12 months and 24 months of follow-up. Musculoskeletal pain also markedly diminished for the group from approximately 25% of adolescents having pain at baseline to less than 10% with pain at 6 months or 12 months and just barely 12% with pain at 24 months. These associations, too, remained statistically significant after controlling for age, sex, race or ethnicity, enrollment site, and baseline BMI.

The authors concluded that adolescent patients experience "meaningful and durable" improvements in their cardiovascular measures and in musculoskeletal pain reduction after bariatric surgery. More importantly, these improvements appear to be sustained as long as 2 years after the surgery.

Viewpoint

I remember cringing at a Pediatric Academic Society session in 2005 that focused on adolescent bariatric surgery. Back then, there was still an active question of whether gastric bypass was a viable option for adolescents. In the decade since, several studies have demonstrated that bariatric surgery may be the only way to get some severely obese patients to lose weight, and this study suggests that the rapid improvements seen in previous studies have a good chance of being sustained. I don't think that this study changes daily practice for most general pediatric clinicians, but it reinforces the fact that bariatric surgery can be truly life-changing for candidates who qualify.

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