Gastric Bypass in Teens Improves Health Dramatically

Obese teens face potentially devastating effects of hypertension, aggressive type 2 diabetes, and bone and joint problems. Historically, we have not considered gastric bypass surgery even though it offers perhaps the greatest chance for long-term weight reduction. But if teens are having adult-sized complications, shouldn't we be performing an adult-sized intervention?^[1]

The Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study was a prospective, multicenter, observational study that examined outcomes of Roux-en-Y surgery in teens compared with those of a similarly treated group of adults.^[2] The goal was to determine whether the secondary complications of obesity would be more likely to improve if the surgery happened during adolescence.

All of the 161 teenagers were evaluated extensively at baseline and seen multiple times over the next 5 years. The 396 adults in the comparison group were between the ages of 25 and 50 years at the time of their gastric bypass surgeries but had developed obesity at age 18 or earlier.

Over 80% of the participants remained active in the study throughout the 5 years. The mean BMI for the adolescent patients at baseline was 53.7 compared with 50.6 for the adults (P < .001). The mean weight loss in the teens was 57 lb compared with 64 lb for the adults, a difference that was not significant. Five years after surgery, 60% of the adolescents and 76% of the adults maintained weight reduction of ≥ 20%, a difference that was statistically significant.

At baseline, 14% of the adolescents had diabetes compared with 31% of the adults. While improvement was seen in both groups by year 5 of the study, only 2% of the adolescents continued to experience diabetes and none were receiving medications at 5 years. In contrast, 12% of the adults continued to have diabetes and a quarter of them required medications.

Both groups saw improvements in hypertension. While the numbers of patients in both groups taking antihypertensive medications at baseline were roughly the same (57% of adolescents and 60% of adults), at 5 years only 11% of adolescents compared with 33% of adults still required them. About 68% of the adolescents taking medication at baseline achieved remission at year 5 while only 41% of adults were able to come off of medications for blood pressure control.

The 5-year death rate for adolescents was 1.9% compared with 1.8% for adults, a difference that was not significant.

The frequency of experiencing subsequent intra-abdominal operations, however, was greater in the adolescent group, at 19.5 per 500 person-years compared with 10.3 per 500 person-years. There was no clear pattern as to why this occurred.

Viewpoint

When I first heard about the successes of adolescent gastric bypass surgery, I wondered how we had come to such a drastic intervention for young patients. Over the years, however, studies have demonstrated that for a very select group of adolescents, gastric bypass may be the only way to make a long-term impact on function and comorbidities, though it is important to acknowledge that even 5 years is a relatively short time period to follow chronic conditions such as diabetes and hypertension.

The fact that adolescents who had bypass surgery improved to a greater extent than did adults adds to the growing body of data suggesting that gastric bypass can be a beneficial approach for a select group of adolescents.

William T. Basco, MD, MS, is a professor of pediatrics at the Medical University of South Carolina and director of the Division of General Pediatrics. He is an active health services researcher and has published more than 60 manuscripts in the peer-reviewed literature.

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