Teen-LABS: Bariatric Surgery Beneficial for Adolescents After 3 Years

Three years after undergoing bariatric surgery, adolescents appear to experience major improvements in their weight, metabolic health, and quality of life, according to a new study ObesityWeek 2015.

After 3 years, average weight reduction was 41 kg, and mean percent weight loss was 27% in the entire cohort, 28% in those who underwent gastric bypass, and 26% in those who underwent sleeve gastrectomy, the researchers reported.

Furthermore, most participants experienced improvements in a number of obesity-related health problems. Remission of type 2 diabetes was noted in 95% of participants; normalization of kidney function was observed in 86%; hypertension was corrected in 74%; and dyslipidemia was reversed in 66%, according to the data.

“There are a number of other adolescent bariatric surgery outcomes reports in the published literature, but none of this size, pooling data from 5 centers, examining adolescent outcomes. Clinical implications are several,” said lead study author Thomas Inge, MD, PhD, who is the surgical director of the weight loss program for teen at Cincinnati Children’s Hospital Medical Center. 

Teen-LABS (Longitudinal Assessment of Bariatric Surgery) — a multicenter clinical study examining the safety and health effects of surgical weight loss procedures — is the largest and most comprehensive analysis of bariatric outcomes to date in adolescents, according to Dr Inge. 

The study enrolled 242 adolescents, aged 13 to 19 years, all of whom were severely obese with an average weight of 149 kg and an average BMI of 53 before surgery.

Dr Inge, who presented the data at the meeting, said the remission rates for medical conditions such as diabetes and hypertension were greater than those seen in many studies of adults who had long-standing obesity before bariatric surgery, noting that it is possible that earlier intervention could lead to better outcomes.

Nutritional risks and other risks associated with surgery were also well documented. The study, which was simultaneously published in the New England Journal of Medicine, showed that fewer than 5% of study participants had iron deficiency before surgery, but more than half had low iron stores 3 years after surgery, supporting the recommendation for monitoring of vitamin and iron supplementation in these patients. 

In addition, 13% of patients required additional abdominal surgery, most commonly gallbladder removal, during the 3-year period. 

“For endocrinologists, the greatest clinical relevance may be that the article adds considerably to the number of adolescents with type 2 diabetes who have undergone treatment with bariatric surgery. The finding of 95% remission of diabetes is greater than the 50% to 70% remission rate of diabetes in adults. These data provide evidence that supports existing clinical practice guidelines for use of bariatric surgery in appropriately selected adolescents with type 2 diabetes,” Dr Inge told Endocrinology Advisor.

Limitations of the study include the fact that it is observational and not a randomized controlled trial, the researchers noted. Another drawback is that the majority of study participants were Caucasian females. However, they also pointed out that this study population represents the patient group seeking surgery at the participating clinical centers.

Moreover, while participants were followed for 3 years after surgery, it is possible that some of the health improvements seen may diminish and other health risks could emerge later. Thus, longer follow-up of adolescents who have bariatric surgery is critical, the researchers added.

Dr Inge said parents, teens, and healthcare providers will now have better estimates of what to expect in terms of weight loss, response of key comorbidities, and abdominal complications over the first 3 years following use of bariatric surgery in adolescence. He explained that clinicians can use this information to help guide medical decision making. 

“One aspect of the findings which should be reason for pause and consideration is that the study found despite a very respectable weight loss, 90 lb on average, a large proportion of these adolescents still did not move out of the severely obese category. While the reasons for this were not addressed in this paper, we speculate that this outcome is influenced by the very high starting BMI. Timing of surgery within the course of excess weight gain will become an important consideration,” said Dr Inge.

References

1. Inge TH. T-OR-2082. Outcomes of Adolescent Bariatric Surgery: A 2 Year Report from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. Presented at ObesityWeek; November 2-6, 2015; Los Angeles, CA.
2. Inge TH, Courcoulas AP, Jenkins TM, et al; for the Teen-LABS Consortium. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med. 2015;doi:10.1056/NEJMoa1506699.