Source:

Inge
TH
,
Courcoulas
AP
,
Todd
MJ
, et al
.
Weight loss and health status 3 years after bariatric surgery in adolescents [published online ahead of print November 6, 2015]
.
N Engl J Med
. doi:
https://doi.org/10.1056/NEJMoa1506699

Investigators at 5 pediatric tertiary care centers in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Consortium conducted a prospective study to determine the effects of bariatric surgery in obese adolescents. For the study, adolescents (≤19 years old) who underwent the procedure from 2007 through 2012 were enrolled. Standardized methods were used for data collection at baseline and at the 6-month and 1-, 2-, and 3-year postoperative visits. Data were collected on weight loss, coexisting conditions, weight-related quality of life, and micronutrient levels. Quality of life was measured using the total score on the Weight on Quality of Life-Kids instrument (scores range from 0–100). Information on surgical and endoscopic procedures performed between 31 days and 3 years after the bariatric surgery was also collected.

Among the 242 study participants, Roux-en-Y gastric bypass was performed in 161, sleeve gastrectomy in 67, and adjustable gastric banding in 14. Because of the small size of the gastric band cohort their results were not included in the main analysis. At baseline, 29% of participants were 13–15 years old, 41% were 16–17 years old, and 30% were 18–19 years old. At baseline, the mean BMI was 53 (range 34–88) and 98% of participants had a BMI >40. Throughout the study interval, 99% (225/228) of the cohort actively participated and 88% (805/912) completed all of the postoperative visits. At 3-year follow-up, mean weight reduction was 41 kg with a mean 27% weight loss; 26% of the participants were no longer categorized as obese. However, 2% of the cohort who underwent gastric bypass and 4% of those who underwent sleeve gastrectomy exceeded their baseline weight.

Compared to baseline, there was significant improvement in comorbidities in study participants by the 3-year follow-up. Hypertension was present in 96 participants at baseline, and normalized in 74% (71/94) of those at 3 years. New-onset hypertension developed in 4 participants. Dyslipidemia was present in 171 participants at baseline and normalized in 66% (112/171) without the use of lipid-lowering drugs. Incident dyslipidemia developed in 3 participants during the study interval. At baseline, 13% (29/233) of participants had type 2 diabetes (mean HgA1C = 6.3%), and at 3 years 19 of 20 participants on whom data were available were in remission. Newonset pre-diabetes developed in 1 participant. The mean quality-of-life score was 63 at baseline and increased to 83 by 3 years (P < .001). Micronutrient deficiencies either continued or worsened over the 3-year study period, including low ferritin levels, low B12 levels, vitamin A deficiency, and vitamin D deficiency. Within 3 postoperative years, 44 additional intra-abdominal surgical procedures related to the bariatric surgery were performed on 30 patients. In addition, upper endoscopic procedures were performed in 29 participants.

The authors conclude that the majority of adolescents who had bariatric surgery experienced...

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