Bariatric Surgery While Young Yields Enduring Health Benefits

Marcus A. Banks

September 23, 2022

Bariatric surgery among adolescents or young adults with severe obesity leads to durable reductions in body weight along with dramatic reductions in rates of diabetes, hypertension, and depression, according to new research in the Journal of the American College of Surgeons.

Approximately 12% of non-Hispanic Blacks, 9% of Hispanics, and 7% of Whites ages 12-19 have severe obesity, the authors note, citing 2018 data in Pediatrics. That paper defines severe obesity as a BMI of at least 35 kg/m2 or greater, or equal to 120% of the 95th percentile for someone's age and sex. For this population, the authors argue, lifestyle modification alone is unlikely to lead to better health.

Dr Sarah Messiah

"Telling people, 'Oh, just eat right and exercise more,' that obviously isn't working," said senior author Sarah Messiah, PhD, MPH, director of the UTSPH Center for Pediatric Population Health in Dallas, Texas. Such advice assumes that people know how to prepare healthy meals or exercise regularly in the first place, which isn't always true, she added.

"Living Normal Lives"

The ongoing study tracks the health outcomes of 96 people (83% female, 75% Hispanic) who received bariatric surgery by the time they were 21 years old (median age, 19). Their median BMI prior to surgery was 44.7 kg/m2 — a figure considered extremely obese. Participants' median weight prior to surgery was 278.5 pounds, ranging from 241.5 to 324 pounds.

Study investigators followed the patients' health outcomes for at least 10, and up to 18, years. Almost all (90%) the patients underwent gastric bypass surgery, with the rest undergoing laparoscopic adjustable gastric banding.

Dr Nestor de la Cruz-Muñoz

Nestor de la Cruz-Muñoz, MD, the chief of bariatric surgery at the University of Miami's Miller School of Medicine, and lead author of the study, completed all the surgeries when he worked at a community-based clinic from 2002 to 2009. Cruz-Muñoz used a variety of methods to reconnect with the patients at least 10 years after their procedures, including phoning or mailing patients to request that they complete a telehealth visit. Of 130 potential study participants, 96 agreed to participate in the research project.

At the telehealth visit, people reported their current weight, lowest weight, the current status of their other comorbidities such as having diabetes or hypertension. Because Cruz-Muñoz is also interested in the effect of bariatric surgery on quality of life, he asked participants about their highest level of education completed, their relationship status, and whether they'd had children.

"I saw that they were living normal lives," Cruz-Muñoz said. Some were college graduates and others were raising families. At the time of surgery, he recalled, the youth were sad because they felt that their weight would forever foreclose these possibilities.

At a mean follow-up of 14 years, people who had received a gastric bypass had lost 31% of their highest weight, and those with the gastric band had lost 22% of their highest weight, according to the researchers. In addition, all patients with presurgery hyperlipidemia (14.6%), asthma (10.4%) and diabetes (5.2%) reported complete remission of these conditions (P < .05 for each condition). Their anxiety and depression levels dropped significantly too, the researchers reported.

A Medical Condition, not a Character Flaw

"The study is important because it finally addresses what happens years and years out," said Kirk Reichard, MD, MBA, director of the bariatric surgery program at Nemours Children's Health, in Wilmington, Delaware. Reichard was not part of this study, but was a lead author of a 2019 policy statement from the American Academy of Pediatrics  that argued that bariatric surgery is safe and effective in children with severe obesity. 

"Obesity is a medical condition; it's not a willpower weakness or a character defect," Reichard said. "If somebody has cancer, we don't impugn their character, we treat the cancer." He called for a similar, nonjudgmental approach to treating severe obesity, one that would include a combination of bariatric surgery and prescribing GLP-1 agonists such as semaglutide (Ozempic), Reichard said.

The researchers reported no relevant financial relationships.

J Am Coll Surg. Published online September 15, 2022. Abstract 

Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

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