Studies have shown that adults with obesity who were obese as adolescents have worse medical outcomes than persons who became obese in adulthood (Nat Rev Endocrinol 2018; 14: 183-8; NEJM 2011; 365; 1876-85). Thus, the question is whether earlier intervention would improve outcomes.
A recent study (TH Inge et al. NEJM 2019; 380: 2136-45, editorial TD Adams, pgs 2175-7) compares the 5-year outcomes of adolescents (n=161) and adults (n=396) who underwent Roux-en-Y gastric bypass (RYGB). The two prospectively enrolled cohorts were participants in two related but independent studies.
- There was similar weight loss in both groups at the 5-year mark: -26% in adolescents and -29% in adults
- Adolescents had greater remission in both type 2 diabetes (86% vs 53%) and in hypertension (68% and 41%).
- Three adolescents (1.9%) and seven adults (1.8%) died in the 5-years after surgery. Two of the adolescents deaths were consistent with overdose.
- Reoperations were significantly higher in adolescents than adults (19 vs 10 reoperations per 500 person years). The authors comment that the reason for this finding is unclear, possibly related to recall bias or closer monitoring of the adolescents.
- Nutrient deficiencies were common in adolescents at followup. After 2 years, 48% of adolescents had low ferritin compared with 29% of adults (98% of participants had normal ferritin prior to RYGB. The authors note that this is likely related to adherence to vitamin/mineral supplementation (which is needed lifelong).
Limitations: observational study design
The associated commentary::
- “Almost 6% of adolescents in the U.S. are severely obese and bariatric surgery is now the only successful long-term management…Negative health outcomes of bariatric surgery reported in adolescents mirror those reported in adults — including, for example, potential for self-harm (including suicide) and increased risk of alcohol or drug abuse.”
- “Adolescent patients may not have fully developed the capacity for decision making, especially about a procedure that will have lifetime consequences.”
My take: This study and commentary point out some clear health benefits for adolescents who undergo RYGB. Given the lifelong need for monitoring and adherence with medical treatment as well as some of the negative health outcomes, it is also clear how challenging it is to proceed with RYGB in teenage years.
Related blog posts:
- 12 Year Data: Pros and Cons of Bariatric Surgery
- How Often Do Children with Obesity Have a Fatty Liver?
- Should teenagers with severe NAFLD undergo bariatric surgery?
- Reaching Consensus on Bariatric Intervention in Children …
- Is a Three Year-Old Too Young for Bariatric Surgery …
- Treating diabetes with surgery | gutsandgrowth
- NAFLD Guidance from American Association for the Study of Liver Diseases
- Psychology of obesity and food addiction | gutsandgrowth
- Staggering cost of obesity | gutsandgrowth