Researchers at Children's Hospital Colorado (Children's Colorado) have found that both younger and older adolescents have similar weight loss, resolution of high blood pressure and high cholesterol, nutritional impacts and improvement in quality of life after bariatric surgery. These results strongly indicate that, when working with adolescents with severe obesity, age alone should not dissuade providers and patients from pursuing surgery when medically indicated.
"Bariatric surgery has become recognised as the safest and most effective treatment for severe obesity in adults; however, little was known about the relative merits and risks of these procedures in the youngest of teens compared to older adolescents," said Dr Sarah B Ogle, a surgery fellow at Children's Colorado. "Thus, discussing the option of surgery in young adolescents with intractable severe obesity makes more sense than continuing ineffective treatments, given the proven benefits of surgery. This study is an exciting step toward demonstrating the safety and efficacy of bariatric surgery in the youngest adolescents."
The study, ‘Outcomes of Bariatric Surgery in Older Versus Younger Adolescents’, published in the journal Pediatrics, compared outcomes data of 228 adolescents enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Each of these patients underwent bariatric surgery. Sixty-six of them were between the ages of 13 and 15 at the time of surgery while 162 of them were between the ages of 16 and 19.
Baseline data were collected within 30 days of surgery and participants were then evaluated at six months, 12 months and then annually, for five years after surgery. Researchers compared BMI change, comorbidity outcomes (hypertension, dyslipidaemia, and type 2 diabetes mellitus), nutritional abnormalities between the younger (13–15 years; n=66) and older adolescents (16–19 years; n=162) participating in the study.
Outcomes
They reported that BMI significantly declined from baseline until one year post surgery (group by time interaction, p=0.60), remained stable between years one and two (p=0.16), and then significantly increased in both groups (p<0.01). The percentage BMI change from baseline was similar between younger (−22.2%; 95% CI: −26.2% to −18.2%) and older (−24.6%; 95% CI: −27.7% to −22.5%) adolescents (p=0.59), five years after surgery.
At baseline, the prevalence of hypertension was 27% (n=18) in younger adolescents and 37% (n=59) in older adolescents (0=0.16) and at five years, remission of hypertension was achieved by 77% (95%) of younger adolescents and 67% of older adolescents (postoperative hypertension remission was similar by age group, p=0.84). Five years after surgery, the incidence of hypertension in the younger group was 8% (n=5), compared with 2% (n=4) in the older group.
Dyslipidaemia was 73% (n=47) in younger adolescents and 77% (n=124) in older adolescents (p=0.57), at baseline. Five-year dyslipidaemia remission was 61% among younger adolescents and 58% among older adolescents. At five years, they reported no significant difference in remission between age groups (p=0.74) and dyslipidaemia at five years was reported in 2% (n=1) of younger adolescents and 4% (n=6) of older adolescents.
For T2DM, 11% (n=7) of younger adolescents and 14% (n=22) in older adolescents (p=0.54) presented with the condition at the start of the study. Remission of type 2 diabetes was achieved by 83% (n=6) of young adolescents and 87% (n=15) of older adolescents at five years, younger adolescents were less likely to achieve remission compared with older adolescent (p=0.046). Five years after surgery, incidence type 2 diabetes was present in 4.5% (n=1) of older adolescents and 0% (n=0) of younger adolescents.
The prevalence of abnormal ferritin, transferrin, vitamin B12, and vitamin A levels significantly increased at five years, and only prevalence of elevated transferrin levels and vitamin D deficiency was significantly different by age group. Younger adolescents were less likely to have elevated transferrin levels (p=0.048) and low vitamin D levels (p=0.034) compared with older adolescents.
"Younger teens have less commonly been considered eligible for surgery due to their age, but the findings in this analysis should shift the focus from a concern about age to more important factors that should drive decision-making. These include providing the patient with the best opportunity to reach a normal BMI after surgery, reversal of serious complications of obesity, and treatment that will most likely increase the lifespan," said Dr Thomas H Inge, Teen-LABS principal investigator, and director of pediatric surgery and the bariatric centre at Children's Colorado. "While these results are promising, longer term study of this early intervention is needed to fully evaluate the impact of surgery to reverse late effects of childhood severe obesity that develop over the decades."
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