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Teen-LABS: Adolescents benefit from bariatric surgery
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Adolescents with severe obesity and various comorbidities presented favorable safety outcomes after bariatric surgery, according to initial data from the Teen-Longitudinal Assessment of Bariatric Surgery Study.
“These findings are an important first step in providing data on the short-term safety of bariatric surgery in adolescent patients,” study researcher Mary Brandt, MD, director of the Adolescent Bariatric Surgery Program at Texas Children’s Hospital and vice chair of education of Baylor College of Medicine’s Michael E. DeBakey department of surgery, said in a press release. “We know that these children are suffering from adult-type diseases at a much younger age. This surgery isn’t just about weight loss, but the positive implications it has on the comorbidities that they face as a result of their obesity as well. In fact, in select patients, bariatric surgery can help reduce the severity, and oftentimes eliminate some of these diseases.”
Mary Brandt
Brandt, along with Thomas H. Inge, PhD, MD, of Cincinnati Children’s Hospital Medical Center, and colleagues conducted the prospective, multisite, observational Teen-LABS Study, which included 242 patients with a mean BMI of 50.5; mean age of 17.1 years.
Roux-en-Y bypass was the most common form of bariatric surgery in 66% of patients, followed by vertical sleeve gastrectomy in 28%, and adjustable gastric banding in 6%, according to researchers.
Approximately half of the patients had three or fewer comorbid conditions, whereas 39% presented with four or five. The most common comorbidities were dyslipidemia (74%), sleep apnea (57%), back and joint pain (46%), hypertension (45%) and fatty liver disease (37%).
After 30 days, 19 patients (7.9%) displayed 20 major complications, and 36 patients (14.9%) displayed 47 minor complications. However, there were no deaths reported.
Thomas H. Inge
“These data demonstrated that 92% of the 242 severely obese adolescents who underwent weight-loss surgery did so without major complications,” researchers wrote.
These study results will also be presented at Obesity Week 2013 in Atlanta.
In an accompanying editorial, Michael G. Sarr, MD, of the Mayo Clinic in Rochester, Minn., wrote that Inge and colleagues have shown that mortality was nonexistent and morbidity was treatable or similar to adults regarding bariatric surgery.
“Adolescence is a crucial time for the development of the emotional as well as social foundation of later life; many of us maintain that the psychosocial retardation (or call it whatever you want — handicap, isolation, impairment — we all know what this means) probably needs to be considered on equal terms as are the more evident metabolic problems of severe obesity; they are all interrelated,” Sarr wrote.
Further longitudinal data from this cohort will provide more insight into the surgery’s effects on comorbidities, physical or metabolic health and health-related quality of life changes, nutritional effects and longevity of weight loss, researchers wrote.
For more information:
Inge TH. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.4296.
Sarr MG. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.4496.
Disclosure: Inge reports research grant funding from Ethicon Endo-Surgery. See the full study for a list of disclosures.
Perspective
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Meredith C. Hitch, MD
Today, nearly 18% of American children are obese with comorbidities, which puts them at risk of being outlived by their parents. Fad diets and gimmicks are ubiquitous — full of empty promise and expense — whereas weight-loss surgery, an intervention shown to produce rapid weight reduction and improvement in weight-related comorbidities, is deemed “too drastic” for teens.
Ideally, adolescents can learn to eat and exercise in ways that lead to large weight losses that are maintained throughout the remainder of life, but the reality is that doing so is exceptionally difficult and, despite impassioned enjoinders from others, few obese persons, young or old, are able to accomplish this.
Inge and colleagues studied the comorbidities, outcomes and safety profile of weight-loss surgery in the early perioperative period of 242 adolescents. They reported that 92% of the patients had no major complications, and a 5% rate of major inpatient morbidity was observed in a population with more significant comorbidities and obesity than adult and other adolescent studies, which suggests that weight-loss surgery is no more risky in teens than in adults.
Thus, weight-loss surgery is safer than the natural history of the comorbidities and is a reasonable tool for weight reduction in the morbidly obese teen with weight-related comorbidities. I look forward to the future studies of this cohort which will assess the metabolic and anthropomorphic profiles of these patients long-term and ascertain outcomes of reversal of comorbidities and improvementClick Here to Manage Email Alerts