COMMENTARY

Teens With Obesity 'Deserve' to Be Offered Bariatric Surgery

Louise A. Baur, BSc (Med), PhD

Disclosures

October 15, 2019

This transcript has been edited for clarity.

Adolescents with obesity and type 2 diabetes (T2D) deserve to be offered bariatric surgery as part of a suite of options for effective treatment. Now, you may be thinking, "Why on earth? What is the evidence for bariatric surgery in this age group?"

We actually have reasonably good evidence. In one randomized controlled trial of bariatric surgery (laparoscopic adjustable gastric banding) in adolescents, half of the adolescents received an intensive lifestyle intervention and half received gastric banding. Two years after the interventions, the group that received bariatric surgery had an average 34 kg weight loss compared with about a 3 kg weight loss in the lifestyle intervention group. There were also differences in other complications associated with obesity. Ten of the participants in the bariatric surgery group and nine in the lifestyle intervention group had the metabolic syndrome before the interventions. After 2 years, all 10 in the surgery group experienced resolution of metabolic syndrome compared with four in the lifestyle group.

Among the number of other studies of bariatric surgery in this age group, the most well known is the Teen-LABS study, which included a prospective cohort of adolescents who had undergone bariatric surgery in five US centers. At 3 years, investigators found clear evidence of improvements in weight and a whole range of cardiometabolic outcomes, including prevalence of T2D and prediabetes. At 5 years, there was a 95% remission in T2D in the young people who had had bariatric surgery. That's quite impressive! You won't get that with ordinary medical management of T2D.

We need to pause and wonder whether our patients should be receiving bariatric surgery. The outcomes for T2D were better in adolescents than they are for adults, perhaps reflecting a less intense disease that existed for a shorter period of time.

Of course, bariatric surgery is never without potential complications, so such things as the possible need for revision surgery and for lifelong nutritional supplementation—and the potential for that to be forgotten—need to be taken into account.

Young people need to be offered the option of bariatric surgery. If they choose to have the surgery, then it needs to be undertaken in centers that have experience with bariatric surgery in this age group, in consultation with a multidisciplinary care team with experience with adolescents. Otherwise, we're not giving young people the access to the good options for treatment that they deserve.

Thank you.

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