Age alone should not be the determining factor for bariatric surgery — researchers found that adolescents experienced similar weight loss, resolution of hypertension and dyslipidemia, nutritional deficiencies, and improvement in quality of life after surgery, regardless of age.
Those researchers, Sarah B. Ogle, DO, MS, Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, and colleagues, published their findings in Pediatrics.
Obesity affects 13.7 million children in the U.S., 6% of whom are severely obese. While intensive medical and lifestyle interventions for treating obesity demonstrate an average of 5%-15% weight loss, the sustainability of those results varies. On the other hand, bariatric surgery has been shown to be a durable treatment for weight loss and the complications associated with obesity.
As pointed out by Ogle and colleagues, a recent update of the pediatric American Society for Metabolic and Bariatric Surgery guidelines eliminated younger age restrictions for bariatric surgery. However, it is estimated that less than 1% of eligible pediatric patients undergo the surgery.
According to the authors, barriers to offering the surgery to pediatric patients include concerns about safety, the impact on growth, patient assent, and compliance with postoperative instructions. In addition, data on long-term outcomes of bariatric surgery on young adolescents and pre-adolescents is limited.
Therefore, in this study, Ogle and colleagues divided the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study into younger and older groups in order to compare surgery outcomes. Teen-LABS was a multicenter prospective observational study involving 242 adolescents who underwent bariatric surgery between 2007 and 2012.
The authors compared outcomes from the 66 participants in the younger group (ages 13-15) and the 162 participants in the older group (ages 16-19). Outcomes included percent BMI change, outcomes related to hypertension, dyslipidemia, and type 2 diabetes mellitus, nutritional abnormalities, and quality of life over five years post-surgery.
Weight loss significantly declined in the year after surgery, stabilized between years 1 and 2, then increased in the years after that in both groups. After five years, the percentage BMI change from baseline was similar between younger and older adolescents (−22.2% and −24.6%, respectively).
In addition, after five year,s no difference in the frequency of remission of hypertension and dyslipidemia was observed in the two groups. Although remission of type 2 diabetes was high in each group, it was statistically higher in older adolescents.
As for nutritional abnormalities, Ogle and colleagues found that younger adolescents were less likely to have elevated transferrin levels or low vitamin D levels than their older counterparts, and that there were no differences in other nutritional deficiencies between groups. “Thus, the risk of nutritional deficiency is not a reason to delay surgery in young adolescents,” they noted.
Quality of life measures significantly improved for both groups by 6 months after surgery and remained similar after that.
“These results appear promising for the treatment of severe obesity in young patients; however, further controlled studies are needed to fully evaluate the timing of surgery and extended long-term durability,” Ogle and colleagues wroter.
The authors added that the average BMI in each cohort was 53, which they suggested indicates both age groups were referred for bariatric surgery on the later side. And since the ability to achieve a normal BMI after bariatric surgery is related to baseline BMI, postoperative success may depend more on lower BMI at the time of surgery, rather than the age of the patient. Furthermore, they pointed out that it is particularly important to intervene when BMI is lower, considering that current medical treatments “have limited success in resulting in weight loss or stabilization in youth with severe obesity.”
“The findings in this study support the use of early intervention based on clinical indication rather than age alone, thereby providing the patient with the best opportunity to reach a normal BMI after surgery, promoting resolution of complications of obesity, and reducing the number of obese years in a child’s lifetime,” Ogle and colleagues concluded.
Limitations of the study include its observational design and potential differences among the participating institutions.
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Bariatric surgery should be considered for young adolescents for whom the procedure is indicated.
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Younger and older adolescents experience similar weight loss, resolution of hypertension and dyslipidemia, nutritional deficiencies, and improvement in quality of life after surgery.
Michael Bassett, Contributing Writer, BreakingMED™
Ogle disclosed no relevant relationships.
Cat ID: 252
Topic ID: 85,252,728,791,730,252,917,159
