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Research background: Do adolescents treated with gastric bypass surgery experience better health outcomes than adults who are treated with the same surgery?
Surgeons most often perform weight loss surgery for severe obesity in adults who are in their forties. The cumulative effects of sustained obesity from adolescence to middle age affect the likelihood of diabetes and cardiovascular disease-related morbidity and mortality. In addition, adults who seek bariatric surgery for obesity from adolescence are more likely to present with diabetes, hypertension and other conditions, compared to adults seeking surgery who were not obese during adolescence.
Thomas Inge, MD, Associate Surgeon-in-Chief, Director of Pediatric Surgery, and Director of the Bariatric Surgery Center at Children's Hospital Colorado and other researchers compared outcomes from adolescent gastric bypass surgery and adult gastric bypass surgery. In this analysis, researchers studied adults who had sustained obesity since adolescence.
Research methods: Evaluating bariatric surgery results
Researchers used data from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Longitudinal Assessment of Bariatric Surgery (LABS) studies to evaluate health effects of gastric bypass surgery on adolescents and adults. Both studies collected data at baseline before bariatric surgery, six months after surgery, and each year up to five years after surgery. Linear mixed and Poisson mixed models were used for statistical analysis of weight changes, comorbidities and micronutrient outcomes.
Research results: Benefits of bariatric surgery for diabetes and other health outcomes in adolescents compared to adults
Weight change at five years post-surgery
Changes in risks and complications of obesity
At five years after surgery, both cohorts experienced similar improvements in non-HDL cholesterol, triglycerides and HDL cholesterol.
For those with diabetes at baseline, 86 percent of adolescents and 53 percent of adults no longer met the definition of diabetes at five years post-surgery. Adolescents were 27 percent more likely to achieve remission of diabetes after bariatric surgery than adults, and they were more likely to achieve glycemic control regardless of medication use after surgery.
Medication use for diabetes
Hypertension was more prevalent in adults compared to adolescents at baseline.
For those with hypertension at baseline, 68 percent of adolescents and 41 percent of adults were in remission at five years post-surgery. Adolescents were 51 percent more likely to achieve remission of hypertension than adults.
Mortality and morbidity in first five years post-surgery
Nutritional measures at two years post-surgery*
Research discussion and conclusion: The benefits of adolescent gastric bypass over adult gastric bypass include risks to consider
Discussion of weight loss and comorbidity outcomes
Researchers found that overall weight loss between both cohorts was similar, but adolescents who underwent gastric bypass surgery experienced more variability in maintenance and weight loss over time. Adolescents were more likely to experience remission of type 2 diabetes and hypertension than adults. The rate of death was similar, but abdominal reoperations were significantly more common among adolescents compared to adults.
Since adolescents with diabetes that underwent gastric bypass surgery could achieve and maintain better glycemic control without medications, they may have a greater opportunity to recovery islet cell secretory capacity compared to adults. This should influence decisions about timing of bariatric surgery for adolescents with diabetes.
Adolescents also achieved a significantly better surgical treatment outcome on hypertension, which suggests that youth may have more capacity for greater plasticity in comorbidity responsiveness to surgery.
Discussion of nutritional outcomes
Previous research shows that ferritin levels decline after gastric bypass surgery. Adolescents also have trouble with adherence to vitamin and mineral supplement recommendations after surgery, so routine use of supplements should be reinforced by their primary care providers.
Benefits of gastric bypass likely outweigh risks
Researchers concluded that gastric bypass results in durable and clinically meaningful weight loss and health improvements in adolescents and adults. Since there was greater improvement in specific metabolic and cardiovascular disease-related comorbidities in adolescents, addressing them earlier in the course of severe obesity could result in fewer complications of obesity over one's lifetime. However, this must be weighed against the modestly increased risks of abdominal reoperations and micronutrient deficiency after adolescent gastric bypass.
Discussion of adverse events
Research has shown a reduction in overall deaths and particularly deaths due to complications of obesity (such as diabetes and heart disease) in adults who underwent bariatric surgery, but some research also suggests that adults who had bariatric surgery have an increased risk of death due to accidental causes, suicide, and poisoning. Our current study found that a similar proportion died in the adolescent (1.9%) and adult (1.8%) group, and also suggests that adolescents may be at risk of death due to overdose.
Abdominal reoperations were more common among adolescents compared to adults, but the cause was not apparent in our data. This too means that more research is needed and in the meantime, adolescents and parents should be aware that there may be a need for future surgery after gastric bypass procedures. It is not clear if the same risk is present for those adolescents who undergo other bariatric operations such as sleeve gastrectomy.