Weight loss, reversed comorbidities sustained 3 years after adolescent gastric bypass

Issue: December 2015

LOS ANGELES — Adolescents who underwent bariatric surgery sustained clinically significant weight loss after 3 years, with many experiencing remission of several comorbid conditions, including diabetes, dyslipidemia and abnormal kidney function, according to study findings presented at ObesityWeek.

Thomas Inge, MD, PhD, FACS, FAAP, director of the Surgical Weight Loss Program for Teens and the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center, and a professor in the department of surgery at the University of Cincinnati, said in the 3 years after bariatric surgery, 13% of adolescents in the cohort also underwent subsequent abdominal procedures, whereas some also experienced micronutrient deficiencies, indicating that there are risks related to surgery in this age group.

Thomas Inge

“Pediatric severe obesity affects nearly 4.5 million children today,” Inge said while presenting his findings. “These [children] are developing myriad health problems, and these health problems accrue over time, and there are few effective treatments, especially for those affected by severe pediatric obesity.”

In an observational study, Inge and colleagues analyzed data from 242 adolescents with severe obesity aged 13 to 19 years (mean age, 17 years; mean BMI, 53 kg/m²; 76% girls; 72% white) who were approved for bariatric surgery and participating in the Teen LABS study. Within the cohort, 21% had a BMI greater than 60 kg/m². Participants underwent either Roux-en-Y gastric bypass (n = 161), vertical sleeve gastrectomy (n = 67) or lap band surgery (n = 14), and they were assessed at baseline, 6, 12, 24 and 36 months for cardiometabolic risk factors, comorbid conditions, postoperative complications and quality-of-life measures.

At 3 years after surgery, mean weight decreased by 27% (95% CI, 25-29); by 28% (95% CI, 25-30) in the gastric bypass group and by 26% (95% CI, 22-30) in the sleeve gastrectomy group. Due to the small number of participants in the lap band group, those children were not included in the analysis, Inge said.

Within the cohort, 95% of participants with type 2 diabetes at baseline experienced remission at 3 years; 86% experienced remission of abnormal kidney function; 76% experienced remission of prediabetes; 66% experienced remission of dyslipidemia.

Weight-related quality of life also significantly improved for participants after surgery, Inge said.

However, participants were found to be deficient in several micronutrients in the 3 years after surgery. Within the cohort, 5% had low ferritin levels at baseline; that number increased to 57% at 3 years. Vitamin B, and vitamin A levels similarly declined. In addition, 13% of participants underwent one or more additional intra-abdominal surgeries, most for cholecystectomy (8% of total cohort).

“Adolescents lost a significant amount of weight, in fact, 90% of them lost 10% or more of their weight over the 3-year period, with major effects on comorbid conditions ... as well as [increased] quality of life,” Inge said. “The emergence of micronutrient deficiencies and subsequent intra-abdominal procedures indicates that these types of issues after surgery do form part of the true informed consent that should be done.”

The full study was also published online in The New England Journal of Medicine. – by Regina Schaffer

References :

Inge TH, et al. OR #2082 Presented at: ObesityWeek; Nov. 2-6, 2015; Los Angeles.

Inge TH, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1506699.

Disclosure: Inge reports receiving bariatric research grant funding from Ethicon Endo-Surgery, and also serving as a consultant for Sanofi Corporation. Please see the full study for the other authors’ relevant financial disclosures.