Gastric Bypass Outcomes in Severely Obese Teens

Additionally, adolescents who had surgery also spent an average of 6.5 days (95% CI, 4.5-8.6) in the hospital, including the time spent for gastric bypass vs 1.6 days (95% CI, 0.9-2.2) in adolescent controls.⁵ They also had more extra visits to an outpatient clinic than adolescents who did not have RYGB (14.6 [95% CI, 11.8-17.3] vs 10 [95% CI, 8.3-11.7]).⁵

Prescription drug costs, however, were similar in adolescents who had surgery and adolescents who did not ($2317 vs $2701).⁵

“Gastric bypass results in substantial weight loss as well as cutting heart and metabolic problems and improving quality of life into the long-term for severely obese teenagers. While some patients may face complications, those given non-surgical treatment often continue to put on weight, putting them at higher risk of poor health throughout life,” Dr Olbers said in the release.⁴ “To reduce risk of complication it’s important that gastric bypass for teenagers is done in centers that can provide the full care needed and long-term follow-up and support.”

Potential Clinical Implications

In a linked comment,⁶ Geltrude Mingrone, MD, PhD, of Catholic University in Italy, explained that lifestyle modifications and medical treatment are often unsuccessful for weight loss in adolescents. Moreover, intensive behavioral interventions that have been shown to be effective are usually less so in adolescents with severe obesity.  

“Before now, only a few short-term studies of bariatric surgery in adolescents have been reported; therefore, these studies provide important data and shed new light on the use of bariatric surgery in young people,” Dr Mingrone wrote.

“Undoubtedly, no other approaches but bariatric surgery are able to provide such considerable weight loss, with only relatively small weight regain, over time.”

Nevertheless, the vitamin deficiencies and the potential of early surgery affecting growth should not be overlooked. Dr Mingrone noted that “it is important that future national guidelines address the matter of the age at which bariatric surgery should be performed in adolescents.”

Disclosures: Dr Inge has served as a consultant for Sanofi. Dr Dixon has a financial relationship with, served a consultant to, or has received research funding or a travel grant from Abbott Australasia, Allergan, Apollo Endosurgery Pharmaceuticals, Bariatric Advantage, Biogen Idec, BUPA, Covidien, Eli Lilly, iNova Pharmaceuticals, Nestle Australia, and Novo Nordisk.

References

1. Inge TH, Jenkins TM, Xanthakos SA, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis [published online January 5, 2017]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(16)30315-1
2. Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study [published online January 5, 2017]. Lancet Diabetes Endocrinol. doi: 10.1016/S2213-8587(16)30424-7
3. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999–2014. Obesity. 2016;24:1116–1123.

   Gastric bypass helps severely obese teenagers maintain weight loss over long term [press release]. New York, NY: The Lancet Press Office; January 5, 2017. www.eurekalert.org/pub_releases/2017-01/tl-tld010417.php. Accessed January 5, 2017.

4. Mingrone G. Pros and cons of bariatric surgery in adolescents [published online January 5, 2017]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(16)30425-9