PFAS exposure and postoperative weight regain in adolescents after bariatric surgery: Findings from the Teen-LABS study

Authors: BAUMERT, BRITTNEY - University Of Southern California; COSTELLO, ELIZABETH - University Of Southern California; LI, ZHENJIANG - University Of Southern California; RYDER, JUSTIN - Northwestern University; INGE, THOMAS - Northwestern University; JENKINS, TODD - Children'S Hospital - Cincinnati, Ohio; SISLEY, STEPHANIE - Baylor College Of Medicine; XANTHAKOS, STAVRA - Children'S Hospital - Cincinnati, Ohio; WALKER, DOUGLAS - Rollins School Of Public Health; STRATAKIS, NIKOS - Barcelona Institute For Global Health, Isglobal; VALVI, DAMASKINI - The Icahn School Of Medicine At Mount Sinai; BARTELL, SCOTT - University Of California Irvine; SLITT, ANGELA - University Of Rhode Island; KOHLI, ROHIT - Children'S Hospital Los Angeles; ROCK, SARAH - University Of Southern California; LA MERRILL, MICHELE - University Of California, Davis; ECKEL, SANDRAH - University Of Southern California; AUNG, MAX - University Of Southern California; MCCONNELL, ROB - University Of Southern California; CONTI, DAVID - University Of Southern California; CHATZI, LIDA - University Of Southern California

Submitted to: Obesity
Publication Type: Review Article
Publication Acceptance Date: 6/18/2025
Publication Date: 8/14/2025
Citation: Baumert, B.O., Costello, E., Li, Z., Ryder, J.R., Inge, T., Jenkins, T., Sisley, S., Xanthakos, S.A., Walker, D.I., Stratakis, N., Valvi, D., Bartell, S.M., Slitt, A.L., Kohli, R., Rock, S., La Merrill, M.A., Eckel, S.P., Aung, M.T., McConnell, R., Conti, D.V., Chatzi, L. 2025. PFAS exposure and postoperative weight regain in adolescents after bariatric surgery: Findings from the Teen-LABS study. Obesity. https://doi.org/10.1002/oby.70009.
DOI: https://doi.org/10.1002/oby.70009

Interpretive Summary: Researchers in Houston, Texas don’t fully understand why some teens gain weight again after having bariatric (weight-loss) surgery. It’s important to learn more so doctors can help these teens stay healthy in the long run. Past studies show that chemicals called PFAS, found in everyday items like fast food wrappers and non-stick pans, can affect how the body handles weight. In this study, teens with higher PFAS levels before surgery were more likely to gain weight back over five years. This means PFAS might make it harder for the surgery to work well over time. Knowing this could help doctors find ways to protect patients from these chemicals and improve their health after surgery.

Technical Abstract: Weight regain following bariatric surgery remains a clinical challenge, with limited understanding of contributing environmental factors. Per- and polyfluoroalkyl substances (PFAS), persistent chemicals linked to metabolic dysfunction, may influence long-term weight trajectories. This study aimed to evaluate associations between PFAS exposure and changes in BMI, percent weight loss, and waist circumference among adolescents after bariatric surgery. We included 186 adolescents (mean age: 17.1'years; 76.3% female; 72.0% White) from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort who underwent surgery between 2007 and 2012. Anthropometric measurements were collected at baseline and 6, 12, 36, and 60'months post surgery. Presurgical plasma concentrations of seven PFAS were measured using liquid chromatography–tandem mass spectrometry. Associations were estimated using linear mixed-effects models and quantile g-computation. Higher concentrations of PFOS, PFHxS, and PFHpS were associated with greater BMI regain, reduced percent weight loss, and increased waist circumference from 1 to 5'years post surgery. At PFOS concentrations of 1.45 to 2.94 log2 ng/mL, annual BMI regain increased from 1.34 to 1.84'kg/m2 (p'='0.0497). Mixture analyses confirmed cumulative PFAS effects, with sulfonic acids showing the strongest associations. PFAS exposure was associated with weight regain after bariatric surgery in adolescents, potentially undermining long-term metabolic benefits.