Increased access to an adolescent-centered healthy weight management program, including bariatric or weight loss surgery, is paramount to achieving the best long-term outcomes as adolescents with obesity grow to adulthood, a new study confirms.
Published online April 11 in Surgical Endoscopy, a journal of the Society of American Gastrointestinal and Endoscopic Surgeons, the study found that adolescents with obesity who received a laparoscopic sleeve gastrectomy (LSG), a surgical procedure to reduce the size of the stomach and lower insulin resistance, benefited from less obesity and concomitant organ damage no matter their age at the time of surgery. This applied to children as young as 13 years of age.
Led by pediatric surgeons at Hassenfeld Children’s Hospital at NYU Langone and Children’s National Hospital in Washington, DC, the study also revealed that adolescents with a parent who received bariatric surgery themselves had a higher weight before weight loss surgery, suggesting the familial nature of chronic obesity.
Childhood obesity occurs when a child is well above the healthy weight for their age and height. It is a complex and serious public health concern that continues to grow in prevalence. According to the Centers for Disease Control and Prevention, pediatric obesity affects 14.4 million infants, children, and adolescents ages 2 to 19 years, and the rate of obesity nearly doubled during the COVID-19 pandemic compared to a pre-pandemic period. This faster increase was most pronounced in younger, school-aged children.
“If obesity has negative effects on overall health, then why not take care of it early?” says study lead author Jun Tashiro, MD, MPH, a pediatric surgeon specializing in bariatric surgery at the Adolescent Healthy Weight Program, part of Hassenfeld Children’s Hospital, and an assistant professor in the Department of Surgery at NYU Grossman School of Medicine. “Addressing the ‘toxic exposure’ with early interventions in any instance as long as it is safe will lower the negative consequences, such as high blood pressure, high cholesterol, diabetes, musculoskeletal problems, breathing problems, anxiety, and depression.”
For teens ages 13 and older who have a body mass index (BMI) of 35 or higher and have been unsuccessful through traditional weight loss measures or who experience obesity-related health conditions, bariatric surgery is a safe, effective treatment toward developing a healthier and more active life.
There have been an increasing number of studies specifically designed to address the safety and effectiveness of bariatric surgery in this younger population, coupled with recent reports highlighting the many health-related medical problems teens with severe obesity face, a national consensus in support of this treatment regimen for younger populations has emerged. However, most facilities nationwide are limited in their ability to treat adolescents younger than 16 years of age. For this reason, younger patients may not have the same access to bariatric surgery as older individuals.
What the Study Found
The new study evaluated the effects of parental history of bariatric surgery, as well as age at the time of operation, on 328 adolescents who received LSG at Children’s National Hospital between January 2010 and December 2019. Among the 31 percent of adolescents younger than 16 years, no differences in weight loss trends were demonstrated in comparison to the 69 percent in those 16 years or older. The study also demonstrated that the 76 patients with parental history of surgery had a higher absolute weight at the time of presentation, suggesting the adherence to the familial, polygenic nature of obesity.
“Although there were no differences in weight loss outcomes for those patients whose parents have or have not had bariatric surgery themselves, given their heavier size at age of surgery, there may be benefit in ensuring even earlier access to care for these children and adolescents,” says Dr. Tashiro.
Multidisciplinary adolescent weight loss programs focus on the entire child and family, addressing the psychological, social, nutritional, hormonal, genetic, activity, neurologic, and sleep issues that may contribute to excess weight gain. The study authors emphasize that freestanding children’s hospitals or those within larger adult facilities are in a unique position to offer bariatric surgery to younger patients, particularly those younger than 16 years of age.
“This study shows that bariatric surgery is just as effective for younger adolescents as for older kids,” says study senior author Evan Nadler, MD, director of the Child and Adolescent Weight Loss Surgery Program at Children’s National Hospital. “Adolescents and teens with severe obesity face many significant barriers to accessing metabolic bariatric surgery, and while they wait, obesity-related comorbidities may continue to develop and impact their health. We as doctors should work together to remove these barriers when appropriate, so more young people who need this safe and effective treatment can get it.”
Further research about how long-term comorbidities develop in adolescents with obesity is warranted for further understanding of the benefits of early bariatric surgery intervention.