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Bariatric Surgery in Adolescents with Severe Obesity

June 16, 2021

Seema Kumar, MD, FAAP

Severe obesity is affecting increasing numbers of youth. While overall rates of childhood obesity are plateauing, severe obesity is on the rise. Nearly 10 percent of 12-to-15-year-olds and 14 percent of 16-to-19-year-olds have severe obesity. An increasing number of these young people are developing what are considered adult diseases: type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, fatty liver disease, and bone and joint dysfunction.  

Lifestyle modifications remain a cornerstone for weight reduction in children with obesity, as noted in research by Armstrong and others in Pediatrics in 2019. However, lifestyle modifications have only modest success, particularly in youth with severe obesity. 

And so far, the role of medications in achieving weight loss in adolescents with severe obesity is not defined. There is little data on the long-term safety and efficacy of weight-loss medications in children.

Bariatric surgery as an option for adolescents  

In adults with obesity, bariatric surgery is the most effective option to achieve weight loss and remission of several comorbid conditions. Recent studies are finding similar results for adolescents. 

Bariatric procedures (laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) have shown good efficacy in achieving weight loss in adolescents with severe obesity. Bariatric surgery in adolescents has been associated with remission or improvement of several obesity-related comorbidities, including type 2 diabetes, hypertension and dyslipidemia. In fact, adolescents who have bariatric surgery experience higher rates of improvements in type 2 diabetes and hypertension than adults who undergo similar surgery. 

The American Society for Metabolic and Bariatric Surgery and the American Academy of Pediatrics have updated guidelines on bariatric surgery for adolescents with severe obesity. Guidelines recommend bariatric surgery be considered for youth with:  

Body mass index (BMI) percentile ≥ 120 percent of the 95th percentile or BMI ≥ 35 kg/m2 (whichever is lower) or more with concurrent obesity related comorbid diseases 

Body mass index (BMI) percentile ≥ 140 percent of the 95th percentile or BMI ≥ 40 kg/m2 (whichever is lower), even in the absence of any obesity related comorbid diseases 

The guidelines, published in 2018 in Surgery for Obesity and Related Diseases, no longer recommend using skeletal growth and pubertal staging to determine eligibility for surgery. The guidelines also suggest consideration of surgery in special cases, such as for children with syndromic obesity or hypothalamic obesity or for patients with limited decision-making capacity.

As these guidelines indicate, surgery should be considered as a treatment option for adolescents with severe obesity – just as surgery would be considered for many other health conditions. Bariatric surgery helps young patients lose weight and stave off weight-associated diseases. The procedure compares in safety to gallbladder surgery.

As with adults, weight regain after surgery is a challenge for adolescents. Close follow-up with a multidisciplinary team helps achieve long-term efficacy. Telemedicine can be very effective to maintain contact with adolescents both before and after surgery. 

For more information:

Armstrong SC, et al. Pediatric metabolic and bariatric surgery: Evidence, barriers, and best practices. Pediatrics. 2019;144:e20193223.

Pratt JSA, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surgery for Obesity and Related Diseases. 2018;14:882.

About the Author

Seema Kumar, MD, FAAP, is chair of Pediatric Endocrinology and Metabolism at Mayo Clinic Children’s Center in Rochester, Minnesota. She is part of the multidisciplinary Adolescent Bariatric Surgery Program at Mayo Clinic. The program is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. 

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