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March 13, 2023

Pediatric Obesity Research Update | Metabolic and Bariatric Surgery in Adolescents

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Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses metabolic and bariatric surgery in adolescents

Metabolic and Bariatric Surgery in Adolescents

Article Summary

There is a growing need to treat obesity in adolescents. In this article from the UK and Sweden, the authors review current evidence to support Metabolic and Bariatric Surgery (MBS) in adolescents and discuss the implications for the future. Read the full article.

Article Review

This article is a timely summary of the status of Metabolic and Bariatric Surgery (MBS) in adolescents with obesity. The authors point out the increasing prevalence of obesity in adolescents and the need for safe, effective treatment in that age group. Similar to adults, the most recent guidelines for adolescent bariatric surgery are from the American Society for Metabolic and Bariatric Surgery. MBS is a viable treatment option for patients with severe obesity and/or obesity-related complications, regardless of tanner stage, as there is no evidence that MBS negatively affects linear growth.

The three most common metabolic and surgical procedures include laparoscopic sleeve gastrectomy (LSG), Roux-en-Y Gastric Bypass (RYGB), and the adjustable gastric band (AGB), with LSG being used most often. Moreover, LSG and RYGB trigger significant changes in gut-brain neuronal and hormonal signaling to improve and sustain satiety. The authors also reviewed the mechanisms of action (restriction and malabsorption) as well as complications, amount of change in weight/BMI, and effects on complications of obesity (i.e., diabetes, hypertension, etc.). Similar to adults, adolescents undergoing MBS experience a decrease in BMI and resolution of or improvement in complications of obesity. On average, 6-month BMI reduction ranges from 11.6 kg/m2 to 16.6 kg/m2, depending on the procedure. Likewise, the greater the reduction in BMI, the more likely the resolution of cardiometabolic complications. There is evidence of the durability of weight loss and reversal of cardiometabolic diseases at 3 and 5 years after surgery.

The authors underscore the importance of involving an interdisciplinary team in the pre-and postoperative evaluation and management to determine suitability and monitor for complications. They also emphasize the importance of talking with adolescent young adults about plans to transition to adult weight management programs when they are ready. Other issues like persistent mental health challenges, biliary tract disease, and excess skin are important matters that require more long-term outcome studies.

In conclusion, the authors call for consideration of combination therapies that include lifestyle adjustments, anti-obesity medications, weight-loss devices, and MBS to assist in the development of improved management pathways of treatment and control of “this complex and debilitating disease” of obesity.

Additional Resources

Find more resources curated by OMA’s Pediatric Committee on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.

Chalklin CG, Ryan Harper EG, Beamish AJ. Metabolic and Bariatric Surgery in Adolescents. Curr Obes Rep. 2021 Jun;10(2):61-69. doi: 10.1007/s13679-021-00423-3. Epub 2021 Mar 16. PMID: 33725324; PMCID: PMC8159783.