Ten-year outcomes after bariatric surgery in adolescents

Authors: RYDER, JUSTIN - 32892; JENKINS, TODD - University Of Cincinnati College Of Medicine; XIE, CHANGCHUN - University Of Cincinnati College Of Medicine; COURCOULAS, ANITA - University Of Pittsburgh Medical Center; HARMON, CARROLL - Children'S Hospital - Buffalo, New York; HELMRATH, MICHAEL - Children'S Hospital - Cincinnati, Ohio; SISLEY, STEPHANIE - Baylor College Of Medicine; MICHALSKY, MARC - Nationwide Children'S Hospital; BRANDT, MARY - Baylor College Of Medicine; INGE, THOMAS - 32892

Submitted to: New England Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/26/2024
Publication Date: 10/31/2024
Citation: Ryder, J.R., Jenkins, T.M., Xie, C., Courcoulas, A.P., Harmon, C.M., Helmrath, M.A., Sisley, S., Michalsky, M.P., Brandt, M., Inge, T.H. 2024. Ten-year outcomes after bariatric surgery in adolescents. New England Journal of Medicine. 391(17):1656-1658. https://doi.org/10.1056/nejmc2404054.
DOI: https://doi.org/10.1056/nejmc2404054

Interpretive Summary: Long-term outcomes after teenagers who had weight-loss surgery, like gastric bypass or sleeve gastrectomy, were unknown. Researchers found that ten years after surgery, most of the individuals who had surgery as teenagers continued to participate in check-ups over the years. The now young adults were able to keep off a lot of weight and had major improvements in conditions like diabetes, high blood pressure, and cholesterol problems. In fact, their long-term diabetes remission rates were much better than those of adults who had similar surgery. While the study had some weaknesses, like not having a comparison group, it still proved that weight-loss surgery can be an effective way to help teens with severe obesity stay healthier in the long run. This study supports continuing to offer weight loss surgery to adolescents and suggest that considering surgery earlier for young people struggling with obesity, alongside newer medications, may show promise.

Technical Abstract: Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective multicenter observational cohort study designed to evaluate adolescents (= 19 years of age) undergoing bariatric surgery (NCT # NCT00474318. Here, we report the 10-year outcomes highlighting durable weight loss and resolution of common obesity-related co-morbidities. Participating adolescents underwent either gastric bypass (n=161) or sleeve gastrectomy (n=99) at mean age 17 years. Overall, 83% of 10-year post-operative visits were completed. BMI change and responses of obesity-related comorbidities were examined using propensity score adjusted, linear and generalized mixed models. At 10 years, BMI significantly declined (-20.0% [-22.9, -17.1] (p<0.001);BMI change was similar for gastric bypass (-20.6% [95%CI:-24.8%,-16.4%]) and sleeve gastrectomy (-19.2% [95%CI: -24.8%,-13.5%]). Latent class analysis identified four distinct BMI change trajectories over time. Cumulative logistical modeling indicated that greater early weight loss (change in BMI at 6 months) was associated with a more favorable long-term BMI trajectory (Odds Ratio: 1.16[1.11,1.21]. Since weight loss and baseline prevalence of type 2 diabetes, hypertension, and dyslipidemia, low HDL cholesterol, and high triglycerides were similar for both surgical procedures in this study, data were collapsed for all comorbidity analyses. Ten years following bariatric surgery, modeled remission rates for type 2 diabetes (55% [95%CI: 35,75], hypertension (57% [95%CI: 39,75], and dyslipidemia (54% [95%CI: 42,66] demonstrated durability of response for most participants. Notably, type 2 diabetes remission at 10 years far exceeded the 18% to 12% remission reported in adults at 7 to 12 years, respectively, in a recent multi-center randomized controlled trial. Strengths of the present study include its prospective, multicenter design with standardized methodology and high cohort retention (>90%). Limitations include the observational study design, small sample size for certain comorbidity outcomes, and lack of a contemporaneous non-surgical control group. While there is heterogeneity in weight loss and cardiometabolic risk factor response, these data support recent guidance for surgical treatment for adolescents with severe obesity. Given the more recent utilization of effective anti-obesity medications, it is imperative to directly study the relative efficacy and risks of medical and surgical treatment approaches--both of which hold major promise to improve the lives and health of pediatric patients with severe obesity. These findings document the long-term durability of weight loss and comorbidity remission and specifically demonstrate the greater health benefits and durability of bariatric surgery in adolescents than would be expected in similarly-treated adults.