Bariatric surgery in adolescents: what do we know so far?

Abstract

Introduction: Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits. Methods: In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options. Results: Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing. Conclusion: Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations.

Should bariatric surgery be performed in adolescents?

“…Life-threatening obesity-related condition (9,80). In addition, attrition rates are relatively high within dietary and lifestyle programs (43,81,82) and, even when these therapies are successful, many individuals' obesity will not resolve as the few kg/m 2 lost represent a small fraction of their overall BMI (83).…”

“…Its prevalence in adolescents is rapidly rising, in parallel with a rising prevalence of obesity (86) and is likely underestimated by up to 50% (87, 88). Alarming evidence suggests that T2DM behaves far more aggressively when onset is in adolescence, with earlier failure of first-line drug pharmacotherapy and more rapid progression to insulin requirement (9,89). A broad evidence base, comprising eleven randomized trials, now describes bariatric surgery as an effective therapy for T2DM in adults, leading not only to the glycemic control seen with pharmacotherapy but also to remission of diabetes in 33-90% of patients (90).…”

“…Patients whose obesity is related to specific genetic mutations, such as MC4R, or syndromes, such as PraderWilli, represent a tiny minority of adolescents undergoing bariatric surgery, strictly as exceptions to recommended exclusion criteria (9). Reported outcomes in these patients have varied widely, but are often inferior to those in 'normal' adolescent obesity (127,128,129).…”

“…In the adolescent, obesity is associated with type 2 diabetes, increased cardiovascular risk (5,6,7) and early cardiovascular changes (6,8). Furthermore, obesity in adolescents leads to a reduction in quality of life and global functional impairment (9,10,11,12). Therefore, effective treatment strategies are urgently needed.…”

Definitions of obesity and current indications for obesity surgery

“…In our country, the prevalence is 8.2%. [32,34] Prevalence of type 2 diabetes (T2DM) has risen is parallel to the increasing prevalence of obesity. In 2011, an estimated 366 million people had diabetes and this number will have reached to 522 million by 2030.…”