Bariatric surgery in the treatment of adolescent obesity: current perspectives in the United States

ABSTRACT

Introduction: Rates of severe obesity in adolescents have increased at an alarming rate. Unfortunately, there are limited successful treatments for severe obesity in adolescents. Metabolic and bariatric surgery (MBS) is the most effective treatment available for adolescents with Class 2 and above severe obesity and has demonstrated variable degrees of sustained long-term weight loss which leads to resolution of multiple associated conditions and an improved quality of life.

Areas covered: We discuss the current landscape of MBS in adolescents and evidence to support its long-term safety and efficacy. A literature search through PubMed, ResearchGate and HOLLIS Harvard Library Online Catalog was performed from the date of inception until 3/15/2021. A combination of the following keywords was used: Pediatric metabolic/bariatric surgery; long term outcomes of Pediatric metabolic/bariatric surgery, perioperative assessment, pediatric metabolic/bariatric surgery barriers; attitudes toward metabolic/bariatric surgery.

Expert opinion: MBS is emerging as a safe and effective treatment strategy for adolescents with severe obesity, with recent studies demonstrating durable and sustainable weight loss. There remains an urgent need for longitudinal studies to assess durability of weight loss. Obesity stigma and bias, limited access to tertiary care centers, and skepticism around the treatment of obesity poses a major challenge.

KEYWORDS:

• Metabolic and bariatric surgery
• class 2 and 3 severe obesity
• adolescent obesity
• health disparities
• outcomes of bariatric surgery
• roux-en-y gastric bypass (rygb) and vertical sleeve gastrectomy (vsg)

Article Highlights

• The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends metabolic and bariatric surgery (MBS) as a safe and effective treatment option for adolescents with BMI ≥ 120% of the 95th percentile with comorbidities including hyperlipidemia, hypertension (HTN), Type 2 Diabetes Mellitus (T2DM), Non- alcoholic fatty liver disease (NAFLD) gastroesophageal reflux disease or those with BMI ≥ 140% of the 95th percentile.

• It is imperative to understand the criticalness for timely treatment of obesity and recognizing it as a disease. This includes referral of patients who meet criteria for surgery to an MBS center with advanced treatments and support.

• The most common types of MBS in adolescents include Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), with VSG now considered the gold standard for bariatric surgery.

• Available literature demonstrating the 5-year outcomes after MBS has shown promising results.

• Barriers to adolescent bariatric surgery include lack of knowledge and negative psychosocial attitudes from providers, patients and their families, and inability to access specialized pediatric weight centers. Disparities in access due to socioeconomic status, public health insurance coverage, and minority race are evident.

• Post-MBS women show better maternal health during pregnancy and nutritional monitoring should be implemented well ahead of conception to tackle neonatal health risks in post-MBS women.

Declaration of interest

S Malhotra has served as a speaker for Rhythm Pharmaceutical. Apart from those disclosed, the authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This project was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, NIH P30 DK040561 (FCS), L30 DK118710 (FCS).