Bariatric Surgery May Have Significant Benefits for Adolescent Patients

Operation using laparoscopic equipment
Adolescents are more likely to have remission of diabetes and hypertension after bariatric surgery compared with adults.

Adolescents are more likely to have remission of diabetes and hypertension after bariatric surgery compared with adults and have similar weight loss outcomes, according to study results published in The New England Journal of Medicine.

To determine how age at the time of surgery affects bariatric surgery outcomes, researchers followed a cohort of 161 adolescents (mean age, 17 years) and 396 adults (mean age, 38 years) who underwent Roux-en-Y gastric bypass. Each cohort was assessed for weight changes and coexisting conditions up to 5 years after surgery, as well as for mortality, subsequent abdominal operations, and micronutrient outcomes (monitored up to 2 years postsurgery). Adult participants were given a weight history questionnaire and were eligible for the study if they had a body mass index ≥30 at age 18.

Using linear mixed and Poisson mixed models, the researchers discovered no significant difference in percent weight change between the cohorts 5 years after surgery, with adolescents losing on average 26% body weight and adults losing on average 29% (P =.08). However, more adults maintained a weight reduction of ≥20% compared with adolescents (76% vs 60%, respectively; P =.02).

Compared with adults, significantly more adolescents had remission of type 2 diabetes (86% vs 53%, respectively; risk ratio, 1.27) and hypertension (68% vs 41%, respectively; risk ratio, 1.51) by year 5.

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Adolescents were significantly more likely than adults to undergo a subsequent abdominal reoperation during this time (19 vs 10 per 500 person-years, respectively; P =.003) and were also more likely to have low ferritin levels in the 2 years after surgery (48% vs 29%; P =.004). Overall, 3 adolescents and 7 adults died in the 5 years after surgery.

Among the limitations noted for this study were its observational design and a lack of nonsurgical controls.

In summarizing their findings, the researchers said, “We have documented similar and durable weight loss after gastric bypass in adolescents and adults, but important differences between these cohorts were observed in specific health outcomes. Longer-term follow-up and further research will be important for refinement of the risks and benefits of bariatric surgery in adolescents.”

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Inge TH, Courcoulas AP, Jenkins TM, et al. Five-year outcomes of gastric bypass in adolescents as compared with adults [published online May 16, 2019]. N Engl J Med. doi:10.1056/NEJMoa1813909