Weight Loss Surgery in Adolescents

Abstract

Childhood obesity continues to be a national health problem, with growing numbers of adolescents (8.7%) affected by severe obesity and its associated cardiometabolic risks. Since current nonsurgical methods for treating these adolescents have only modest effects, weight loss surgery (WLS) is an alternative treatment. An overview of the literature was conducted describing the selection, management, and outcomes of adolescents undergoing WLS. Adolescent guidelines require physical and emotional maturity as well as serious comorbidities associated with body mass index cutoffs higher than those used for adults. Medium-term to long-term outcomes are similar to those of adults undergoing WLS. Such outcomes depend on management by a multidisciplinary team with expertise in caring for adolescents who are still developing psychosocially and who are relatively more dependent on family supports for continued care. Future exploration is needed to elucidate optimal surgical indications for adolescents, improved adherence to postoperative care, and the impact of WLS on life expectancy. Resulting evidence can better inform the direction for healthcare delivery and policy directed toward this at-risk population.

Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity

“…A total of 36 studies were found that met the search criteria. The majority of studies were reviews ( n = 16, Table ), 8 were observational, 7 were case‐control studies, 3 were quasi‐experimental/case‐control studies, and 2 were RCTs (1 was a methods paper only) (Table ). No studies that tested the combination of pharmacotherapy interventions with MBS were found.…”

“…Indeed, the field has been shortsighted in terms of incorporating neighborhood, built environment, and community aspects and strategies into weight‐loss success and maintenance strategies for MBS patients in particular. Other reviews included the importance of the preoperative assessment tools and postoperative multidisciplinary teams (e.g., dietitian, social worker, psychologist) , clinical dietary recommendations , and cosmetic (e.g., skin) considerations, but none did so in a theoretical framework or by citing evidence‐based findings from previously successful secondary prevention lifestyle interventions. The three review papers that included pharmacotherapy support interventions highlighted the need for more research focused on combination therapies (MBS, pharmacotherapy, lifestyle) to support precision medicine treatment approaches among adolescents with severe obesity.…”

Childhood obesity: Aetiology, comorbidities, and treatment

“…Bariatric surgery is a treatment modality that has been studied in the paediatric patient with obesity. However, it is reserved for cases in which there has been a resistance in weight loss and control of comorbidities after the implementation of the changes in lifestyles and/or pharmacological management (see Table ) . Bearing in mind that this intervention has shown significant benefits in adults at the level of weight reduction and control of comorbidities and a significant impact on the reduction of mortality, in the last 20 years, there has been an increase in the number of procedures in the adolescent population .…”

“…However, it is reserved for cases in which there has been a resistance in weight loss and control of comorbidities after the implementation of the changes in lifestyles and/or pharmacological management (see Table ) . Bearing in mind that this intervention has shown significant benefits in adults at the level of weight reduction and control of comorbidities and a significant impact on the reduction of mortality, in the last 20 years, there has been an increase in the number of procedures in the adolescent population . The evidence in this population group is limited, and more epidemiological studies are needed to highlight the main benefits and their impact in the short and long term .…”

“…Bearing in mind that this intervention has shown significant benefits in adults at the level of weight reduction and control of comorbidities and a significant impact on the reduction of mortality, in the last 20 years, there has been an increase in the number of procedures in the adolescent population . The evidence in this population group is limited, and more epidemiological studies are needed to highlight the main benefits and their impact in the short and long term . A Cochrane systematic review of 2015 regarding the role of bariatric surgery in adolescents indicated that this intervention, independently of surgical techniques, had beneficial results in some comorbidities of obesity such as dyslipidemia and type 2 DM and a positive impact on the quality of life of the paediatric patient .…”