Most recent update: Friday, June 8, 2018 - 12:16

Bariatric News - Cookies & privacy policy

You are here

adolescent bariatric surgery

'Cautious approach' for adolescent bariatric surgery

Lack of strong evidence for successful and cost-effective obesity management strategies

A new study published in the journal, Clinical Obesity, reports that bariatric surgery can result in significant weight loss in severely obese adolescents, but warns of the potential effects of medical complications on the young.

The researchers, led by Ange Aikenhead of the International Association for the Study of Obesity in London, UK, determined that there was a lack of strong evidence for successful and cost-effective obesity management strategies. As a result they performed a systematic review to examine the effectiveness of surgical interventions to treat obese children and adolescents, and whether they are cost-effective. 


Aikenhead and colleagues searched various databases for articles examining subjects less than 19 years of age reporting at least one postoperative weight loss measure and at least one year of postoperative follow-up. They searched PubMed, ISI Web of Science, Embase and the Cochrane Library to September 2010, and hand-searched bibliographies. Articles with English abstracts were included if they examined subjects ≤19 years of age, reported at least one postoperative weight loss measure and at least one year of postoperative follow-up.

Thirty-seven relevant papers on bariatric surgery effectiveness in 831 children or adolescents were included, spanning 36 years. Thirteen studies examined gastric banding, with mean BMI reductions ranging from 8.5 to 43. Weight gain was reported in one case study. Eight papers examined Roux-en-Y gastric bypass, with mean BMI reductions ranging from 9 to 25.

"A cautious approach to child and adolescent bariatric surgery is warranted, and reversible techniques are advisable compared to approaches that permanently alter anatomy" Ange Aikenhead

Fourteen publications studied other forms of bariatric surgery: sleeve gastrectomies, vertical banded gastroplasty, biliopancreatic diversion or a combination of procedures. Mean BMI reductions ranged from 9 to 24. Three surgery-related mortalities were reported, as was weight regain in several cases. The majority of studies reported resolution or improvement of comorbid conditions.


A range of postoperative complications were identified across surgery types, including: ulcers, intestinal leakage, wound infection, anastomotic stricture, nutritional deficiencies, bowel obstruction, pulmonary embolism, disrupted staple lines, band slippage, psychological intolerance and repeated vomiting. Evidence on cost-effectiveness was limited to one Australian modelling project, which deemed laparoscopic adjustable gastric banding cost-effective for adolescents. 


The authors concluded that the existing evidence (although based generally on underpowered, retrospective studies) suggests that bariatric surgery in older children results in significant weight loss and improvements in comorbidities and quality of life. However, postoperative complications, compliance and follow-up may be more problematic in adolescents than adults, and availability of long-term data on safety, effectiveness and cost-effectiveness remains largely unknown. 


“Pending an improvement in the quality of available evidence, a cautious approach to child and adolescent bariatric surgery is warranted, and reversible techniques are advisable compared to approaches that permanently alter anatomy," said Aikenhead. "The obesity epidemic now affects children as well as adults, with obesity and its associated morbidities and costs increasing in scale. Establishing effective methods for treating severe obesity in children will not only reduce the prevalence of childhood obesity and related ill health, but inhibit the progression of obese children to obese adults, a crucial step in combating the epidemic.

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.