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ObesityWeek’15

Surgery reverses T2DM in 95 percent of adolescents

Credit: Walter Siegmund
Surgery also achieves major weight loss and improves quality of life

Three years after undergoing bariatric surgery adolescents experienced major improvements in their weight, metabolic health, and quality of life, according to the outcomes from Teen-LABS (Longitudinal Assessment of Bariatric Surgery), a multi-centre clinical study examining the safety and health effects of surgical weight loss procedures. The results were published in Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents, The New England Journal of Medicine and presented at ObesityWeek. Previous research has shown that only 2 percent of severely obese teenagers can lose weight and keep it off without surgery.

Thomas Inge

“This study shows that at three years, almost 90 percent experienced clinically meaningful weight loss, and participants were in better health, with improved quality of life scores,” said Dr Thomas Inge, principal investigator and lead author of the study. He is also surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center.  “The remission rates for medical conditions such as diabetes and hypertension are greater than those we see in many studies of adults who had long-standing obesity before bariatric surgery. It is possible that earlier intervention could lead to better outcomes. If sustained, the improvements seen in weight, blood sugar, kidney function, blood pressure, and lipid levels may translate into fewer strokes, heart attacks and other disabilities later in life.”

Teen-LABS is the largest and most comprehensive analysis of bariatric outcomes to date in adolescents. The study enrolled 242 adolescents, ages 13 to 19, all of whom were severely obese with an average weight of 325lbs before surgery. The participants had an average BMI53. A total of 161 patients received a Roux-en-Y gastric bypass and 67 patients had a sleeve gastrectomy. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated three years after the procedure.

Three years after surgery, average weight had decreased by over 90lbs (27 percent) and most participants also had reversal of a number of important obesity-related health problems: reversal of type 2 diabetes was seen in 95 percent and normalisation of kidney function was seen in 86 percent. Hypertension corrected in 74 percent and lipid abnormalities reversed in 66 percent.

Nutritional and other risks associated with surgery were also well documented. The study found that fewer than 5 percent of study participants had iron deficiency before surgery, but more than half had low iron stores three years after surgery, supporting the recommendation for monitoring of vitamin and iron supplementation in these patients. In addition, 13 percent of patients required additional abdominal surgery, most commonly gallbladder removal, during the three-year period. 

“We are also learning that once teens have crossed into these extremes of obesity, only 25 percent of them can achieve weights in the normal range after surgery, and over half of them remain severely obese even after surgery,” said Dr Michael Helmrath, a study co-author and adolescent bariatric surgeon at Cincinnati Children’s. “Timing of surgery may prove important.” 

Limitations of the study include the fact that it is observational and that the majority of study participants are Caucasian females. However, this study population represents the patient group seeking surgery at the participating clinical centres. In addition, while participants were followed for three years post-surgery, it is possible that some of the health improvements seen may diminish and other health risks could emerge later. Thus, longer follow-up of adolescents who have bariatric surgery is critical.

“Long-term studies like this one will help paediatricians and paediatric subspecialists have informed and balanced discussions with teen and their families about anticipated benefits and risks of bariatric surgery, especially important given that so many of us are now routinely caring for severely obese adolescents with significant health problems,” said Dr Stavra Xanthakos, a study co-author and paediatric gastroenterologist at Cincinnati Children’s.

"Collaborating with colleagues around the country in a study of this magnitude is very significant for those of us treating severely obese adolescents with serious health problems," said Dr Marc P Michalsky, surgical director of the Center for Healthy Weight and Nutrition at Nationwide Children's and one of the study's co-authors. "The current study show significant improvement in many of the obesity-related conditions, including high blood pressure, diabetes, impaired kidney function and elevated cholesterol levels to name a few. In addition, remission rates of diabetes and hypertension in particular, appear to be greater than in corresponding studies in adults. Such improvements early in life could translate into significant long-term health benefits if sustained."

"The latest results from this multi-institution clinical research study further demonstrates the importance of having effective treatment options for our patients," said Dr Ihuoma Eneli, director at the Center for Healthy Weight and Nutrition at Nationwide Children's. "This critical work further emphasizes the importance of combining lifestyle behaviour changes with any surgical treatment, which is why at Nationwide Children's, we offer a comprehensive approach focused on lifestyle interventions, prevention and advocacy."

Teen-LABS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH). The study is being conducted at five clinical centres in the US, including Cincinnati Children's,  Nationwide Children’s Hospital, Texas Children's Hospital, the Children’s Hospital of Alabama, the University of Pittsburgh Medical Center, and the University of Cincinnati.

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