Weighing the Risks and Benefits of Adolescent Bariatric Surgery

By Jenna Haines
Friday, November 1, 2019

New research finds that following bariatric surgery, severely obese adolescents are more likely than their adult counterparts to experience complete remission of key comorbidities.

An article recently published in The New England Journal of Medicine comparing the weight-loss and health outcomes of adolescents five years after Roux-en-Y gastric bypass surgery with those of adult counterparts highlighted the potential benefits of undergoing bariatric surgery earlier in life.

The Teen–Longitudinal Assessment of Bariatric Surgery (Teen–LABS) study, which focused on adolescents, was created using the same design features and data collection forms employed by the original LABS study, which focused on adults. Additionally, the comparison data from the LABS study was narrowed down to participants who self-reported having been obese — a BMI of 30 or above — at age 18.

“We observed that adults and adolescents had comparable weight-loss outcomes,” says Todd Jenkins, PhD, MPH, Associate Professor of Surgery and Co-Director of the Data Coordinating Center at Cincinnati Children’s Hospital and statistician for the Teen-LABS study. “However, we noted differences in regards to comorbid conditions, as adolescents were significantly more likely to achieve or maintain remission of hypertension [68% versus 41%] and Type 2 diabetes [86% versus 53%] through the five-year follow-up period.”

Addressing Obesity Earlier

The results may bolster arguments that adolescents should not wait until adulthood to pursue bariatric surgery. Previous research indicates that while positive lifestyle changes may be able to help overweight individuals achieve long-term weight loss, it is unlikely to benefit individuals who have sustained obesity long-term.

“If you have an overweight adolescent whose weight is greater than the 99th percentile [which typically correlates to a BMI of approximately 40 or higher], that child is almost guaranteed to grow up and become an obese adult,” says Brian Carmine, MD, FACS, Surgical Director of the Adolescent Weight-Loss Surgery Program at Boston Children’s Hospital, who was not involved with this study. “No diet or exercise regimen has been shown to be successful in getting adolescents above that percentile down to a healthy weight.”

Additionally, Dr. Carmine notes, severe obesity has been found to have a cumulative effect, which means delaying surgery could reduce the impact of the operation.

“We have known for some time that waiting to operate on adults only decreases the likelihood that they will resolve their comorbidities or prevent them from developing,” Dr. Carmine says. “This study has both further confirmed that data and extended it to the adolescent population. If you have an obese adolescent who is almost guaranteed to become an obese adult and has a family history of Type 2 diabetes — and you know that operating can help prevent the disease from developing — the argument for earlier intervention becomes pretty clear.”

Risks of Adolescent Bariatric Surgery

While adolescents in the Teen-LABS study were more likely to experience a complete remission of hypertension and Type 2 diabetes than their adult counterparts, some negative results, including increased risks for intra-abdominal reoperations and micronutrient deficiencies, were observed.

Dr. Carmine acknowledges concerns about whether adolescents are capable of making a choice that will affect the rest of their lives and dealing with the potential psychological implications of that choice. However, he says those issues can be mediated through the implementation of a quality screening program prior to surgery.

“In my experience, I find that adolescents are more likely to see their weight as the root of all their problems, and we have to deal with some of those underlying issues before we can address the obesity factor,” Dr. Carmine says. “That is why you cannot just show up to our office on Monday and undergo gastric bypass surgery on Friday, and why candidates spend a minimum of six months working with a multidisciplinary team of specialists, including licensed social workers and psychologists. While a history of mental health struggles is not a contraindication, it is our job to make sure those factors are optimized and managed first.”

“Only 10 years ago, there was a lot of stigma surrounding bariatric surgery in the adult population. Many saw it as radical and dangerous to patients’ health, and they viewed its recipients as being lazy or having somehow brought obesity on themselves. Now, most referring providers understand that the risk of surgery is dwarfed by the risk of having Type 2 diabetes or high blood pressure, and that blaming patients for being obese is ridiculous.”
— Brian Carmine, MD, FACS, Surgical Director of the Adolescent Weight-Loss Surgery Program at Boston Children’s Hospital

The Future of the Teen-LABS Study

According to Jenkins, the Teens-LABS study currently has the funding necessary to continue following its adolescent cohort through the 10-year mark.

“Going forward, however, we are interested in really digging in and closely evaluating those metrics related to micronutrient deficiencies, and we are starting to look at bone health in regard to bone density and risk of fracture,” Jenkins says. “Additionally, as our study population continues to age, some of them are starting to have children, and we think it is also important that we monitor the progress of the surgical recipients’ offspring.”

While this study focused on adolescents who received Roux-en-Y gastric bypass surgery, Jenkins notes that researchers also have data collected from dozens of adolescents who underwent vertical sleeve gastrectomy — currently the most common bariatric procedure in the U.S. — and that Teen-LABS hopes to evaluate and report on those findings in coming years, as well.