BACKGROUND Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. METHODS We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure. RESULTS The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures. CONCLUSIONS In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micro-nutrient deficiencies and the need for additional abdominal procedures. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; Teen-LABS ClinicalTrials.gov number, NCT00474318.)

BACKGROUND-Bariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear.METHODS-We evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts.RESULTS-There was no significant difference in percent weight change between adolescents (−26%; 95% confidence interval [CI], −29 to −23) and adults (−29%; 95% CI, −31 to −27) 5 years after surgery (P = 0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-Address reprint requests to Dr.

Ethicon Endosurgery, National Center for Advancing Translational Sciences (US National Institutes of Health).

Behaviour and genetic structure are intimately related: mating patterns and patterns of movement between groups or populations influence the movement of genetic variation across the landscape and from one generation to the next. In hybrid zones, the behaviour of the hybridizing taxa can also impact the incidence and outcome of hybridization events. Hybridization between yellow baboons and anubis baboons has been well documented in the Amboseli basin of Kenya, where more anubis-like individuals tend to experience maturational and reproductive advantages. However, it is unknown whether these advantages are reflected in the genetic structure of populations surrounding this area. Here, we used microsatellite genotype data to evaluate the structure and composition of baboon populations in southern Kenya. Our results indicate that, unlike for mitochondrial DNA, microsatellite-based measures of genetic structure concord with phenotypically based taxonomic distinctions and that the currently active hybrid zone is relatively narrow. Isolation with migration analysis revealed asymmetric gene flow in this region from anubis populations into yellow populations, in support of the anubis-biased phenotypic advantages observed in Amboseli. Populations that are primarily yellow but that receive anubis gene flow exhibit higher levels of genetic diversity than yellow populations far from the introgression front. Our results support previous work that indicates a long history of hybridization and introgression among East African baboons. Specifically, it suggests that anubis baboons are in the process of gradual range expansion into the range of yellow baboons, a pattern potentially explained by behavioural and life history advantages that correlate with anubis ancestry.

WHAT'S KNOWN ON THIS SUBJECT: Adverse effects of excess weight are likely related to both obesity severity and duration. Little is known about the contribution of adolescent weight status to development of specific comorbid conditions in adults.WHAT THIS STUDY ADDS: Severe obesity at age 18 was independently associated with increased risk of lower extremity venous edema, walking limitation, kidney dysfunction, polycystic ovary syndrome, respiratory conditions, diabetes, and hypertension in adulthood.abstract OBJECTIVE: To test the hypothesis that adolescent obesity would be associated with greater risks of adverse health in severely obese adults. METHODS:Before weight loss surgery, adult participants in the Longitudinal Assessment of Bariatric Surgery-2 underwent detailed anthropometric and comorbidity assessment. Weight status at age 18 was retrospectively determined. Participants who were $80% certain of recalled height and weight at age 18 (1502 of 2308) were included. Log binomial regression was used to evaluate whether weight status at age 18 was independently associated with risk of comorbid conditions at time of surgery controlling for potential confounders.RESULTS: Median age and adult body mass index (BMI) were 47 years and 46, respectively. At age 18, 42% of subjects were healthy weight, 29% overweight, 16% class 1 obese, and 13% class $2 obese. Compared with healthy weight at age 18, class $2 obesity at age 18 independently increased the risk of lower-extremity venous edema with skin manifestations by 435% (P , .0001), severe walking limitation by 321% (P , .0001), abnormal kidney function by 302% (P , .0001), polycystic ovary syndrome by 74% (P = .03), asthma by 48% (P = .01), diabetes by 42% (P , .01), obstructive sleep apnea by 25% (P , .01), and hypertension (by varying degrees based on age and gender). Conversely, the associated risk of hyperlipidemia was reduced by 61% (P , .01). CONCLUSIONS:Severe obesity at age 18 was independently associated with increased risk of several comorbid conditions in adults undergoing bariatric surgery. Dr Inge conceptualized and designed the study, drafted the initial manuscript, and revised the manuscript; Dr King drafted the initial manuscript, carried out the initial analyses and revised the manuscript; Ms Chen carried out the initial analyses and reviewed and revised the manuscript, and approved the final manuscript as submitted; Dr Mitsnefes assisted with analysis and interpretation of metabolic data and critically reviewed and revised the manuscript; Dr Daniels substantially contributed to analysis and interpretation of cardiovascular risk factor data and critically reviewed and revised the manuscript; Drs Zeller and Horlick substantially contributed to the conception and design of the study and critically reviewed and revised the manuscript; Dr Khandelwal substantially contributed acquisition of data and critically reviewed and revised the manuscript; Dr Jenkins substantially contributed to the study design and analysis of data and critically reviewed and r...

Background & Aims Little is known about the prevalence of nonalcoholic fatty liver disease (NAFLD) among severely obese adolescents or factors that determine its development. We investigated the prevalence of NAFLD in a multicenter cohort of adolescents undergoing bariatric surgery and factors associated with it. Methods We enrolled 242 adolescents undergoing bariatric surgery between March 2007 and February 2012 at 5 tertiary care centers into a multicenter, prospective observational cohort study. Intra-operative core liver biopsies were collected from 165 subjects; 17 were excluded because of insufficient liver tissue or use of hepatotoxic medications, so 148 remained in the study (mean age 16.8±1.6 y old; median body mass index [BMI], 52 kg/m2). Liver tissues were analyzed by histology using validated criteria. Hepatic gene expression was analyzed in 67 samples. Results NAFLD was present in 59% of this predominantly female (72%), white (68%), non-Hispanic (91%) cohort. Of subjects with NAFLD, 24% had borderline and 10% had definite nonalcoholic steatohepatitis (NASH). Mild fibrosis (≤ stage 2) was observed in 18% of liver biopsies and stage 3 in 0.7%, but cirrhosis was not detected. Dyslipidemia was present in 78% of subjects, hypertension in 44%, and diabetes in 14%. More severe NAFLD was associated with increasing levels of alanine aminotransferase (ALT), fasting glucose level, hypertension (each P<.01) and white blood cell count (P=.04). Only diabetes was associated with detection of fibrosis (odds ratio, 3.56; 95% confidence interval, 1.93–6.56). Microarray analysis associated presence of NASH with altered expression of genes that regulate macrophage chemotaxis, cholesterol absorption, and fatty acid binding. Conclusions More than half of adolescents undergoing bariatric surgery in this cohort had NAFLD, yet the prevalence of severe or fibrotic NASH was low. Increasing severity of NAFLD was associated with level of ALT and cardio-metabolic risk factors, but not BMI. Based on gene expression analysis, borderline and definite NASH were associated with abnormal immune function, intestinal cholesterol absorption, and lipid metabolism.

Objective-Surgical treatment of extreme obesity may be appropriate for some adolescents. We hypothesized that surgical weight loss outcomes may differ by preoperative level of extreme obesity (body mass index [BMI] ≥99th percentile).Study design-A longitudinal assessment of clinical characteristics from 61 adolescents who underwent laparoscopic Roux-en-Y gastric bypass at a single pediatric center from 2002 until 2007 was performed. Patients were categorized into 1 of 3 preoperative BMI groups: group 1, BMI = 40.0 to 54.9 (n = 23); group 2, BMI = 55.0 to 64.9 (n = 21); group 3, BMI = 65.0 to 95.0 (n = 17). Changes in BMI and cardiovascular risk factors between baseline and year 1 were evaluated using repeatedmeasures mixed linear modeling.Results-BMI in the overall cohort at baseline (60.2 ± 11 kg/m 2 ) decreased by 37.4% at 1 year after surgery (P < .001). Percent BMI change varied little by preoperative BMI groups (−37.2%, −36.8%, and −37.7% for groups 1, 2, and 3 respectively; P = .8762). The rate of change in absolute BMI units significantly varied by preoperative BMI class (group × time interaction, P < .0001), with 1-year nadir BMI values for groups 1, 2, and 3 falling to 31 ± 4 kg/m 2 , 38 ± 5 kg/m 2 , and 47 ± 9 kg/ m 2 , respectively. One year after surgery, only 17% of patients achieved a nonobese BMI (<30 kg/ m 2 ). Significant improvements in systolic and diastolic blood pressure (P < .0001), fasting insulin (P < .0001), total cholesterol (P = .0007), and triglyceride levels (P < .0001) were seen after surgery irrespective of baseline BMI class. Mean albumin levels remained normal despite significant caloric restriction and weight loss.Conclusions-Laparoscopic gastric bypass resulted in improvement or reversal of cardiovascular risk factors and resulted in a decrease in BMI of approximately 37% in all patients, regardless of starting BMI, 1 year after surgery. The timing of surgery for adolescent extreme obesity is an important consideration, because "late" referral for bariatric surgery at the highest of BMI values may preclude reversal of obesity.Pediatric obesity is recognized as one of the most significant public health issues in the United States. cardiopulmonary disease, and the metabolic syndrome. In addition, numerous orthopedic, neurological, and gastroenterological conditions threaten the health of adolescents affected by excess weight. 3-8 Increasingly, weight loss surgery is being performed in extremely obese adolescents to effectively treat these comorbidities. 9 Early results from a retrospective study of outcomes in adolescents undergoing bariatric surgery suggest that health and weight loss outcomes will be similar if not better than results seen in adults. 10 The BMI spectrum for adolescents seeking surgery is broad, with values in the literature ranging from 35 to 95 kg/m 2 , with average BMI values much higher than those seen in most adult surgical practices. However, to date, no analysis has been done that examines adolescent surgical outcomes stratified by baseline BMI. E...

Importance Severe obesity in childhood is a major health problem with few effective treatments. Weight loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally-invasive procedures. Objective To assess preoperative clinical characteristics perioperative safety outcomes of severely obese adolescents undergoing WLS. Design This prospective, multi-site observational study enrolled from 2007 through 2012. Setting This study was conducted at 5 academic referral centers in the U.S Participants Consecutive subjects ≤ age 19 years who were approved to undergo (n=277) were offered enrollment into the study; 13 declined participation and 22 did not undergo surgery after enrollment thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. Main Outcomes & Measures This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Re-operations and hospital re-admissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. Results Mean age of participants was 17.1±1.6 years and the median BMI was 50.5 kg/m2. Fifty-one percent demonstrated four or more major co-morbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of subjects, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg., reoperation) were seen in 19 subjects (8%). Minor complications (eg., readmission for dehydration) were noted in 36 subjects (15%). All re-operations and 85% of re-admissions were related to WLS. Conclusions & Relevance In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed a favorable short-term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery.