Adolescent Bariatric Surgery: Current Concepts and Future Directions
Purpose of Review
This review intends to discuss the current status of childhood and adolescent bariatric surgery, including short- and mid-term outcomes, complications, and controversies. Additionally we will highlight potential future directions of pediatric weight loss procedures specifically in regard to procedures.
To date, adolescent bariatric surgery appears to be the most effective way to treat adolescent and pediatric obesity in the short term. Not only does surgery offer the benefit of significant weight loss that is sustainable based on adult literature and the short-term data that we have in pediatric and adolescent literature, but there are significant improvements and resolutions to obesity-associated comorbidities. The recent literature converge on the importance and necessity of further studies which follow patients into adulthood in order to provide a better understanding of the long-term effects of surgery on the adolescent population, resolution of comorbidities, the benefits to the patient, and the impact on life expectancy. Adolescent surgical outcomes and comorbidities appear to mimic adult data, and some studies show that children and adolescents respond better to bariatric surgery with better results than the adults in regard to comorbidities.
Effective management of overweight and obese pediatric and adolescent patients requires early identification and surgery for those patients who would most benefit from surgical treatment. To date, pharmacotherapy, behavior modification, and dietary changes do not have long-term sustainability in regard to maintaining a healthy weight in these children. Appropriate utilization of bariatric surgery among the pediatric and adolescent population is important in preventing obesity transmission, and its complications, into adulthood. Long-term data will address many questions and concerns of parents, patients, and primary care physicians. Until effective non-surgical options become available, weight loss surgery is the only viable option. Future endeavors and new research favor creation and use of less invasive safer procedures that incur less risk with maximum benefit, and study of the patients’ unique physiology in a search for different treatments as well as prevention options.
KeywordsPediatric obesity Adolescent bariatric surgery Gastric bypass Vertical sleeve gastrectomy Adjustable gastric banding
Compliance with Ethical Guidelines
Conflict of interest
Kristen A. Calabro and Carroll M. Harmon declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010:peds. 2009–1955.Google Scholar
- 3.Barlow S. The expert committee: expert committee recommendations on the assessment, prevention, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S124–92.Google Scholar
- 9.Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. Hyattsville: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2017.Google Scholar
- 10.Collaborators GO. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.Google Scholar
- 26.Xanthakos SA, Inge TH. Surgical management of severe obesity in adolescents. UpToDate. 2014;31:2016.Google Scholar
- 30.••Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5(3):165–73. This study is important because in contrast to previous works, FABS-5+ had a prospective cohort design with a long period of follow-up (7 years after surgery); a high level of participant retention post surgery was also achieved, thereby minimizing the effect of loss to follow-up bias on long-term results.Google Scholar
- 40.Cameron JL, Cameron AM. Current surgical therapy e-book. Amsterdam: Elsevier; 2016.Google Scholar
- 43.••Beamish AJ, Reinehr T. Should bariatric surgery be performed in adolescents? Eur J Endocrinol. 2017;176(4):D1–15. This study is of importance as the authors of the case for an the case against bariatric surgery in adolescents agree that bariatric surgery offers superior therapeutic outcomes, in terms of weight loss and resolution of comorbid disease states, over other existing treatments for severe obesity in adolescence. They believe that when other treatments for adolescent severe obesity are unsuccessful, it is appropriate to consider the use of bariatric surgery, within the context of existing guidance.PubMedGoogle Scholar
- 46.Jelin E, Daggag H, Speer A, Hameed N, Lessan N, Barakat M, et al. Melanocortin-4 receptor signaling is not required for short-term weight loss after sleeve gastrectomy in pediatric patients. Int. J. Obes. 2016;40(3):550.Google Scholar
- 51.Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.Google Scholar
- 52.•Michalsky MP, Inge TH, Jenkins TM, Xie C, Courcoulas A, Helmrath M. Cardiovascular risk factors after adolescent bariatric surgery. Pediatrics. 2018;141:e20172485. This study is important as collectively the data demonstrates a reduction in the risk for development of cardiovascular disease in adulthood and offers additional, compelling support for adolescent bariatric surgery.PubMedPubMedCentralGoogle Scholar
- 68.Ryder JR, Edwards NM, Gupta R, Khoury J, Jenkins TM, Bout-Tabaku S, et al. Changes in functional mobility and musculoskeletal pain after bariatric surgery in teens with severe obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Pediatr. 2016;170(9):871–7.PubMedPubMedCentralGoogle Scholar
- 75.Daniels SR, Kelly AS. Pediatric severe obesity: time to establish serious treatments for a serious disease. New Rochelle: Mary Ann Liebert, Inc.; 2014.Google Scholar
- 79.Manco M, Mosca A, De Peppo F, Caccamo R, Cutrera R, Giordano U, et al. The benefit of sleeve gastrectomy in obese adolescents on nonalcoholic steatohepatitis and hepatic fibrosis. J Pediatr. 2017;180(31–7):e2.Google Scholar
- 85.Chan D, Li A, Chu W, Chan M, Wong E, Liu E, et al. Hepatic steatosis in obese Chinese children. Int. J. Obes. 2004;28(10):1257.Google Scholar
- 86.Xanthakos SA, Jenkins TM, Kleiner DE, Boyce TW, Mourya R, Karns R et al. High prevalence of nonalcoholic fatty liver disease in adolescents undergoing bariatric surgery. Gastroenterology. 2015;149(3):623–34. e8.Google Scholar
- 87.Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN Clinical Practice Guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64(2):319–34.PubMedPubMedCentralGoogle Scholar
- 92.Nobili V, Vajro P, Dezsofi A, Fischler B, Hadzic N, Jahnel J, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr. 2015;60(4):550–61.PubMedGoogle Scholar
- 96.Ames M, Leadbeater B. Overweight and isolated: the interpersonal problems of youth who are overweight from adolescence into young adulthood. Int J Behav Dev. 2017;41(3):390–404.Google Scholar
- 97.Astrand I. Aerobic capacity in men and women with special reference to age. Acta Physiol Scand. 1960;49(169):1–89.Google Scholar
- 107.Averett S, Corman H, Reichman NE. Effects of overweight on risky sexual behavior of adolescent girls. Econ Inq. 2013;51(1):605–19.Google Scholar
- 109.Ratcliff MB, Jenkins TM, Reiter-Purtill J, Noll JG, Zeller MH. Risk-taking behaviors of adolescents with extreme obesity: normative or not? Pediatrics. 2011:peds. 2010–742.Google Scholar
- 112.Reece L, Sachdev P, Copeland R, Thomson M, Wales J, Wright N. Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; impact on weight, physical activity, cardiorespiratory fitness and psychosocial well-being. Int. J. Obes. 2017;41(4):591.Google Scholar
- 114.U.S. Food and Drug Administration. UPDATE: potential risks with liquid-filled intragastric balloons—Letter to Health Care Providers. 2017. https://www.fda.gov/MedicalDevices/Safety/LetterstoHealthCareProviders/ucm570707.htm. Accessed 10 Aug 2018.
- 115.U.S. Food and Drug Administration. The FDA alerts health care providers about potential risks with liquid-filled intragastric balloons. 2017. https://www.fda.gov/MedicalDevices/ResourcesforYou/HealthCareProviders/ucm540655.htm. Accessed 10 Aug 2018.