Adolescents suffering with severe obesity who underwent bariatric surgery before the age of 22 had significant and lasting reductions in weight and comorbidities after surgery, according to researchers from UTHealth Houston and the University of Miami. The researchers believe the study contains the longest follow-up data currently available on adolescents suffering with severe obesity after weight-loss surgery, revealing that they lost 31.3% of their weight and kept it off more than a decade later. They also had a 100% remission in diabetes, asthma, and elevated lipids. The results of the study, ‘Long-Term Outcomes after Adolescent Bariatric Surgery’, were published in the Journal of the American College of Surgeons.
“There are long-term benefits to completing bariatric surgery before the age of 22,” said Dr Sarah Messiah, senior author of the study and professor and director of the Center for Pediatric Population Health at UTHealth School of Public Health-Dallas. “The durability of the positive health outcomes isn’t well known this far out at this young age. It’s been a gap in understanding that this research has helped fill.”
Messiah has been working with lead author and bariatric surgeon, Dr Nestor de la Cruz-Munoz, at the University of Miami, for 15 years on research examining outcomes of bariatric surgery for adolescents.
“It’s like a deep sigh of relief to see results that validated we have been doing good for 20 years for these patients, even if they were lost to follow-up,” de la Cruz-Munoz said. “Some of these children are severely depressed, and if we can change these kids’ lives while they are in high school or before they go to college, it can give them a fresh start and hope for a better life.”
While many patients in the study were lost to the bariatric team because of insurance coverage issues or relocations, study results revealed they were followed by paediatricians and primary care physicians for any health issues and complications were rare.
“What sets this study apart is that 74% of the patients who underwent surgery are Hispanic, and 84% are Hispanic or non-Hispanic Black. We know that minority groups are disproportionately impacted by obesity, and this shows that they benefited from the surgery, and thus surgery can be a tool to address these disparities,” explained Messiah.
In the U.S., nearly 12% of non-Hispanic Black adolescents, 9% of Hispanic adolescents and 7% of non-Hispanic white adolescents ages 12 to 19 suffer from severe obesity, meaning a body mass index (BMI) percentile at or above the 99th percentile for their age and gender. This puts them at higher risk for developing cancer and chronic diseases including cardiovascular disease, diabetes, kidney disease, and liver disease.
A total of 96 patients who completed surgery at 21 years of age or younger in a tertiary academic centre 2002 to 2010 were contacted for a telehealth visit. Body weight, comorbidity status, social/physical function status and long-term complications were evaluated ten to 18 years after surgery. The mean participant (83% female, 75% Hispanic) age at surgery was 18.8 (±1.6) years (median age 19 years, range 15-21 years), and median pre-MBS BMI was 44.7 kg/m 2 (SD 6.5).
At follow-up (mean 14.2 [±2.2] years) post-surgery (90.6% Roux-en-Y gastric bypass [RYGB] or 8.3% laparoscopic adjustable gastric banding [LAGB]) mean total body weight decreased by 31.3% (interquartile range [IQR] 20.0% to 38.9%); 32.0% (IQR, 21.3% to 40.1%) among RYGB participants and 22.5% (IQR, 0.64% to 28.3%) among LAGB participants. Patients’ BMI rates dropped from 44.9 before surgery to the lowest BMI of 25.2 after surgery, a 44.4% decrease.
Patients with pre-surgical hyperlipidaemia (14.6%), asthma (10.4%) and diabetes/hyperglycaemia (5.2%) reported 100% remission at follow-up (p<0.05 for all). Pre-post decrease in hypertension (13.5% vs 1%, p=0.001), sleep apnoea (16.7% vs 1.0%, p<0.001), gastroesophageal reflux disease (13.5% vs 3.1%, p=0.016), anxiety (7.3% vs 2.1%, p=0.169) and depression (27.1% vs 4.2%, p<0.001) were also found.
Moreover, of the 96 respondents enrolled in the study, 86.5% reported improved dietary habits since surgery, 60.4% engaged in regular physical activity and more than half of the women, 67%, went on to have a successful pregnancy and birth.
“Adolescents are the fastest-growing segment of the severe obesity epidemic in the US and the COVID-19 pandemic has exacerbated the problem,” added Messiah. “The evidence from this study supports recent recommendations from the American Academy of Pediatrics to increase access to surgery for adolescents. We hope this data could change barriers to access for these children.”
Funding for the study came in part from grants from the National Institute on Minority Health and Health Disparities of the National Institutes of Health.
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