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Obesity comorbidities more likely to resolve after bariatric surgery for teens vs. adults
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NASHVILLE, Tenn. — Adolescents and adults experience similar amounts of weight loss after bariatric surgery, but treatment earlier in life is more likely to resolve diabetes and hypertension, according to study results presented here.
“If we look at these data, we can’t ignore the fact that teenagers are developing very severe obesity with comorbidities, and the comorbidities are more readily treatable and reduce or reverse more readily at these younger years,” Thomas Inge, MD, PhD, associate surgeon-in-chief for research, professor and director of pediatric surgery and founder of the adolescent bariatric surgery center at Children’s Hospital Colorado in Aurora, told Endocrine Today. “That message needs to get out. We need to treat every patient individually, but by and large, there are many patients that could benefit from surgery that are not getting it. Data changes minds, and the natural consequence of this should be that more teenagers with more severe obesity and comorbidities get access, particularly those with diabetes.”
For the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, Inge and colleagues enrolled 161 adolescents with severe obesity aged 19 years or younger (mean baseline BMI, 54 kg/m2; mean age, 17 years; 72% girls) and compared their data with those from the LABS study on 396 adults (baseline BMI, 51 kg/m2; mean age, 38 years; 68% women) who had obesity since at least age 18 years. Both groups underwent Roux-en-Y gastric bypass for the treatment of severe obesity — teens between 2006 and 2012 and adults between 2006 and 2012 — and researchers assessed BMI and cardiovascular outcomes for 5 years after surgery.
“Our hypotheses were that we’d see durable weight loss in both groups, but we worried about what is the staying power, the durability of any weight-loss effort,” Inge said during the presentation. “We also reasoned that if we’re operating, doing something significant early in life before these obesity-related health problems are entrenched, could we turn back the metabolic hands of time as well or better by operating in youth?”
At 5 years, the adolescents and adults had similar percent change in BMI, 29% vs. 26%, respectively. Additionally, both groups showed resolution of diabetes at 5 years, but the effect was greater for the teens: 14% of the adolescent cohort had diabetes at baseline, which dropped to 2% at 5 years, compared with 31% of the adults at baseline, which decreased to 12% at 5 years. Diabetes resolved in 86% of the teens and 53% of the adults who had diabetes at baseline (P < .05). Resolution of baseline hypertension was also more likely in the adolescent vs. adult groups, from 30% to 15% of the teens and from 61% to 39% of the adults (P < .001).
Researchers did not observe between-group differences in changes in lipid levels and no differences in death rates, although reoperation rates within 5 years were higher for teens at 19.45 per 500 person-years vs. 10.43 per 500 person-years for adults (P < .05).
“Adolescents and adults do experience similar weight loss, and both of them experience durable weight loss, which is an important message,” Inge said. “Surgical treatment earlier in the course of obesity resulted in a greater likelihood of reversal of diabetes and hypertension, and that is a significantly reassuring message that can come out of this work. These health benefits, however, do need to be weighed in light of the potential of increased risks, nutritional risks and surgical risks. It’s the comorbidity resolution that is more significant in my mind than any difference in complications or adverse effects.”
Inge said the researchers looked at gastric bypass because that was the procedure being performed in 2006. In an interview after the presentation, he said gastric banding was not typically successful in teens, with an average weight loss of only 5% at 5 years in the ongoing Teen LABS study.
“I don’t think it’s to impugn the actual device or the surgery, but these devices take chronic management and adjustments to get optimal performance,” Inge said.
More successful is sleeve gastrectomy. “Our optimism based just on continuing to look at our own data is high for a procedure with the [gastric] sleeve that has lower theoretical risks, and we are documenting lower actual risks with the hard outcomes as well,” he said. – by Jill Rollet
Reference:
Inge T. T-OR-2036. Presented at: ObesityWeek 2018; Nov. 11-15, 2018; Nashville, Tenn.
Disclosure: Inge reports he is a consultant for Independent Medical Consulting Services and Up to Date and receives honoraria from and holds stock options in Standard Bariatrics.