Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

Abstract

Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.

Is Bariatric Surgery an Option for Obesity in Autism Spectrum Disorder?

“…To the best of our knowledge, there is no study or case report about bariatric surgery in children and adolescents with ASD in the literature. Current literature shows that bariatric surgery is safe and effective in morbidly obese adolescents (Till et al, 2021). Considering the increasing prevalence of obesity, bariatric surgery applications in individuals with ASD seem to be an issue that may come to the fore (Curtin et al, 2010).…”

Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice

“…Good results were reported regarding sustained weight loss, improvement or resolution of comorbidities, and compliance at follow-up [3,5,7,8]. It also has significant advantages in terms of metabolic effects compared to the other techniques [31]. Several longitudinal studies demonstrated 38-83% excess weight loss following VSG compared to non-surgical interventions alone [3,29,32].…”

"Metabolic Syndrome “As a Risk” for Pediatric Age Contemporary Considerations"

“…Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) guidelines should be followed when building an adolescent metabolic and bariatric surgery (MBS) program. It is the responsibility of the adolescent MBS program to have a transition plan in place for adolescents to transition to an adult MBS program for lifelong care [64][65][66][67][68].…”