April 3, 2026
Pediatric Research Update: Pediatric Metabolic and Bariatric Surgery and Antiobesity Medications
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Article Summary #
Treatment Across the Care Continuum in Adolescent Obesity Management: This article reviews the complexity of treating adolescents affected by obesity using antiobesity medications and metabolic bariatric surgery, the potential role of concurrent versus singular treatment strategies and highlights and the need for further research to define optimal timing of these therapies in the adolescent population.
Article Review #
The treatment landscape for adolescents affected by obesity in the United States has changed dramatically over the past few years. This article highlights the growing impact of adolescent obesity, current information, epidemiology, unique features of adolescent obesity, barriers to care and reviews current treatment options, including antiobesity pharmacotherapy and metabolic bariatric surgery (MBS).
The article examines both treatment modalities across two key dimensions: long-term outcomes and cost-effectiveness. Even though GLP-1 receptor agonists (GLP-1RAs) medications are more accessible, the cost of this medication for 9-12 months is equal to the cost of MBS. Even if the difference in cost is not an issue, the outcomes of MBS in adolescents have shown it to be a more durable option. In the Teen-LABS study, adolescents who had MBS, 51% of the patients kept off 32.8% of their total body weight loss at 10 years post-operatively.
The authors discuss the potential role of using both treatments concurrently rather than sequentially. Some adolescents may benefit from using GLP-1RA medication prior to surgery to reduce their body mass index to a level that allows for safer surgical outcomes. Additionally, continuing the medication postoperatively may help optimize weight loss after surgery. This was demonstrated in a study cohort in which patients were offered continuation of their medication two weeks after surgery, resulting in a 6.5% greater BMI reduction in six months compared with those who did not restart therapy. For patients who were not taking medications preoperatively, anti-obesity medications may also play a key role in preventing and treating postoperative weight regain.
The side effects of both treatments were thoroughly reviewed and discussed. For GLP-1 receptor agonists (GLP-1RAs), common gastrointestinal side effects highlighted, along with potential complications such as pancreatitis and gallbladder disease. Concerns associated with MBS included surgical risks, post op complications and nutritional deficiencies, particularly involving vitamin B12, ferritin, and vitamin A.
The authors also discussed improvements in obesity-related comorbidities, which were more prominently associated with MBS outcomes. Reported benefits included a 72% resolution rate for type 2 diabetes and a 57% remission rate for hypertension. A crucial point emphasized that adolescents that had MBS, showed that despite significant weight loss, the procedure did not negatively affect their vertical growth velocity.
Further discussion highlights the need for additional research exploring these treatment modalities, as there remains a significant gap in the literature regarding the use of these therapies either sequentially or concurrently. Expanding pediatric obesity programs that offer comprehensive care, including lifestyle interventions, anti-obesity medications, and adolescent MBS may help optimize treatment strategies and improve long-term outcomes for adolescents with obesity.
Reframing obesity treatment in the adolescent population using a chronic disease model would shift the perspective from viewing treatment as a one-time intervention to recognizing it as part of a continuous, long-term care process. This approach emphasizes that obesity, like other chronic conditions, requires ongoing monitoring, multidisciplinary support, and adjustments in therapy over time. Rather than focusing solely on a single treatment modality such as medication or surgery care would, instead, be viewed as an evolving care continuum that may include lifestyle interventions, pharmacotherapy, surgical options, and long-term follow-up. Adopting this model may improve the sustainability of weight management, support the prevention and treatment of weight regain, and promote better long-term health outcomes for adolescents living with obesity.
Implications for adult and pediatric obesity specialists include advocating for patients access to evidence-based care, including treatment for adolescents affected by obesity and its associated comorbidities. Obesity specialists play a key role in educating not only colleagues in primary care but also other specialists on effective obesity treatment which improves quality of life, reduces the risk and severity of other chronic diseases. In addition, continued efforts are needed to address and decrease bias and stigma surrounding obesity.
Obesity specialists are uniquely positioned to initiate and promote future research and quality improvement (QI) initiatives aimed at addressing existing gaps in literature. Through these efforts, they can help expand the evidence needed to strengthen and advance the future of obesity care.
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Chinn, J. O., Woo Baidal, J. Pratt; J.S.A., Shepard, W. E. & Fell, G. L. (2025). Pediatric Metabolic and Bariatric Surgery and Antiobesity Medications; Weighing Efficacy, Risks, and Future Directions. Journal of Pediatrics, 283, pp 1-8. DOI: 10.1016/j.jpeds.2025.114610
Article reviewed by:
Denise M. Kilway, DNP, RN, CPNP-PC, DiplACLM
Denise is a board certified pediatric nurse practitioner with over 2 decades of clinical experience working with children, teens, and families who are affected by obesity. She holds multiple leadership roles across institutional, state, and national levels in pediatric obesity care and advocacy. She serves as Director of the NEW Kids Program and Co-Director of the LMC Program, guiding interdisciplinary teams focused on evidence-based management of childhood obesity. She is an active member of the Adolescent Bariatric Program, an accredited multidisciplinary team delivering specialized care to adolescents with severe obesity. Nationally, she contributes to professional standards and advocacy efforts through the Obesity Medicine Association’s Pediatric Subcommittee, where she serves on the Advocacy subgroup. At the state level, she supports obesity prevention and treatment initiatives as a member of the Executive Committee of the Wisconsin Obesity Society and is newly elected to one of the non-physician Obesity Medicine Association Board of Trustees.
V. Sushma Chamarthi, MD, FAAP, DABOM
V. Sushma Chamarthi, MD, FAAP, DABOM is a board-certified pediatrician and diplomate of the American Board of Obesity Medicine. She practices primary care pediatrics at Valley Children’s Healthcare in Fresno, California. Dr. Chamarthi serves as Chair of the Childhood Nutrition and Obesity Prevention Committee for AAP California Chapter 1 and also Editor-in-Chief for Pediatrics and Obesity Medicine at StatPearls Publishing. Her clinical and academic work focuses on pediatric obesity management, ultra-processed food exposure, early intervention strategies, and translating evolving obesity guidelines into practical primary care implementation.