Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity



Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be considered a safe option for treatment of adolescent obesity. This study aimed to assess the outcomes of SG in treatment of severe obesity in adolescents, with emphasis on the impact of baseline body mass index (BMI) and adherence to follow-up.


This was a single-center retrospective cohort study on adolescents with severe obesity who underwent SG at a tertiary referral bariatric center. The main outcome measures were weight loss, improvement in comorbidities at 12 months postoperatively, and complications.


A total of 72 adolescent patients (47 female) of a mean BMI of 47.9 ± 7.1 kg/푚2 were enrolled in the study. The mean %TWL was 34.94 ± 9.35 and the mean %EWL was 73.47 ± 22.12. Complete remission was recorded in all patients with type 2 diabetes mellitus (DM), pre-DM, and sleep apnea, in 80% of patients with hypertension, and 57% of patients with hypothyroidism. The long-term complication rate after SG was 18%. Patients with higher preoperative BMI had significantly (p = 0.018) lower %EWL at 1 year.


SG is an effective and safe surgical procedure for adolescents with severe obesity. It was associated with a significant weight loss, high comorbidity remission rates, and no mortality or serious complications. Lower baseline BMI and better adherence to follow-up were associated with better outcome of SG.

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  1. 1.

    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020.

  2. 2.

    Radwan H, Ballout RA, Hasan H, et al. The epidemiology and economic burden of obesity and related cardiometabolic disorders in the United Arab Emirates: a systematic review and qualitative synthesis. J Obes. 2018;2018:2185942–23.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Al-haddad FH, Little BB, Abdul Ghafoor AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. Ann Hum Biol. 2005;32(1):72–9.

    Article  PubMed  Google Scholar 

  4. 4.

    Bin Zaal A, Brebner J, Musaiger A, et al. Anthropometric characteristics and obesity among adolescents in the United Arab Emirates. East Mediterr Health J. 2011;17(05):382–6.

    Article  Google Scholar 

  5. 5.

    Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard growth study of 1922 to 1935. N Engl J Med. 1992;327:1350–5.

    CAS  Article  Google Scholar 

  6. 6.

    UnitedHealth Group. (2010). Diabetes in the United Arab Emirates: crisis or opportunity?

  7. 7.

    Zeller M, Kirk S, Claytor R, et al. Predictors of attrition from a pediatric weight management program. J Pediatr. 2004;144:466–70.

    Article  Google Scholar 

  8. 8.

    Childhood and adolescent obesity. American Society for Metabolic and Bariatric Surgery.

  9. 9.

    Panagiotis L, Gianpaolo D, Giuseppe D, et al. Laparoscopic sleeve gastrectomy for adolescents under 18 years old with severe. Obes Surg. 2020;30:267–73.

    Article  Google Scholar 

  10. 10.

    Hsia DS, Fallon SC, Brandt ML. Adolescent bariatric surgery. Arch Pediatr Adolesc Med. 2012;166(8):757–66.

    Article  PubMed  Google Scholar 

  11. 11.

    Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–20. discussion 420-412.

    Article  Google Scholar 

  12. 12.

    Biter L, Grotenhuis B, Zengerink J, et al. Laparoscopic sleeve gastrectomy versus gastric bypass in late adolescents: what is the optimal surgical strategy for morbid obesity? Eur J Pediatr Surg. 2016;26(06):487–93.

    Article  PubMed  Google Scholar 

  13. 13.

    World Health Organization. The global strategy for women’s, children’s and adolescents’ health (2016-2030).

  14. 14.

    Sawyer SM, Azzopardi PS, Wickremarathne D, et al. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8.

    Article  PubMed  Google Scholar 

  15. 15.

    Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701.

    Article  Google Scholar 

  16. 16.

    ICD-10-CM section T80-T88. ICD. Codes - your free medical coding resource.

  17. 17.

    Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606.

    Article  PubMed  Google Scholar 

  18. 18.

    Reinhold RB. Critical analysis of long term weight loss following gastric bypass. SurgGynecolObstet. 1982;155(3):385–94.

    CAS  Google Scholar 

  19. 19.

    Al-Sabah SK, Almazeedi SM, Dashti SA, et al. The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity. Obes Surg. 2015;25(1):50–4.

    Article  PubMed  Google Scholar 

  20. 20.

    El-Matbouly MA, Khidir N, Touny HA, et al. A 5-year follow-up study of laparoscopic sleeve gastrectomy among morbidly obese adolescents: does it improve body image and prevent and treat diabetes? Obes Surg. 2018;28(2):513–9.

    Article  PubMed  Google Scholar 

  21. 21.

    Alqahtani AR, Antonisamy B, Alamri H, et al. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg. 2012;256(2):266–73.

    Article  PubMed  Google Scholar 

  22. 22.

    Aridi HD, Fawal H, Shaghoury I, et al. Efficacy and safety of laparoscopic sleeve gastrectomy in adolescents. Bariatric Surg Pract Patient Care. 2016;11(2):78–83.

    Article  Google Scholar 

  23. 23.

    Nadler EP, Barefoot LC, Qureshi FG. Early results after laparoscopic sleeve gastrectomy in adolescents with morbid obesity. Surgery. 2012;152(2):212–7.

    Article  PubMed  Google Scholar 

  24. 24.

    Pourcher G, De Filippo G, Ferretti S, et al. Short-term results of single-port sleeve gastrectomy in adolescents with severe obesity. Surg Obes Relat Dis. 2015;11(1):65–9.

    Article  PubMed  Google Scholar 

  25. 25.

    Nocca D, Nedelcu M, Nedelcu A, et al. Laparoscopic sleeve gastrectomy for late adolescent population. Obes Surg. 2014;24(6):861–5.

    Article  PubMed  Google Scholar 

  26. 26.

    Elbanna H, Ghnnam W, Negm A, et al. Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity. Ulusalcerrahidergisi. 2016;32(4):238–43.

    Article  Google Scholar 

  27. 27.

    Ochner CN, Jochner MCE, Caruso EA, et al. Effect of preoperative body mass index on weight loss after obesity surgery. Surg Obes Relat Dis. 2013;9(3):423–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89.

    Article  PubMed  Google Scholar 

  29. 29.

    Vuolo G, Voglino C, Tirone A, et al. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg. 2016;30:48–55.

    Article  PubMed  Google Scholar 

  30. 30.

    Sharma V, Coleman S, Nixon J, et al. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev. 2019;20(10):1341–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Pham S, Gancel A, Scotte A, et al. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes. 2014;638203.

  32. 32.

    Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.

    Article  PubMed  Google Scholar 

  33. 33.

    Bobowicz M, Lehmann A, Orlowski M, et al. Preliminary outcomes 1 year after laparoscopic sleeve gastrectomy based on bariatric analysis and reporting outcome system (BAROS). Obes Surg. 2011;21:1843–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Inge T, Courcoulas A, Jenkins T, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(20):1988–90.

    Article  Google Scholar 

  35. 35.

    Inge TH, Jenkins TM, Xanthakos SA, 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.

    Article  PubMed  Google Scholar 

  36. 36.

    Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017;47(7):844–50.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Medina ARS, Walston M, Xu J, et al. Characteristics of weight regain following sleeve gastrectomy in an adolescent bariatric program. Surg Obes Relat Dis. 2017;13(10):S70.

    Article  Google Scholar 

  38. 38.

    Coupaye M, Rivière P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83.

    Article  PubMed  Google Scholar 

  39. 39.

    Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg. 2014;80(5):466–71.

    Article  Google Scholar 

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We would like to express our great appreciation and thanks to the General Surgery team, Operation Theatre staff, and the Surgical Wards’ staff in Al-Qassimi Hospital for their hard work, constant support, and encouragement.

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Correspondence to Tarek Mahdy.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval for the study was obtained from the Research Ethics Committee.

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Mohammed, M.R., Mahdy, T., Hashem, A. et al. Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity. OBES SURG (2021).

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  • SG
  • Sleeve gastrectomy
  • Adolescents’ obesity
  • Bariatric surgery
  • Laparoscopic sleeve gastrectomy