Monday, May 27, 2019
Given that our efforts to stop the childhood obesity have so far yet to show any signs of success and that treatment efforts of kids already struggling with excess weight have been sketchy at best, there is unfortunately a growing number of adolescents living with severe obesity, for who we have very little choice but to consider bariatric surgery.
As drastic as surgery may seem, it is important to recognise that for adolescents weighing in at 250 lbs or more, waiting and hoping for obesity to spontaneously resolve, while these kids miss out on opportunities ranging from education to social relationships (never mind the bullying and discrimination), is hardly an acceptable option.
Thus, a study by Thomas Inge and colleagues published in the New England Journal of Medicine, showing that 5-year outcomes of adolescents undergoing bariatric surgery are as positive as in (most) adults, is heartening.
The study looks at 5-year outcomes in 161 adolescent patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009) undergoing Roux-en Y gastric bypass surgery.
Overall, the extent of weight loss 5 years after surgery in the adolescents (-26%) was similar to that in adults (-29%). Adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%) and of hypertension (68% vs. 41%).
Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. In the adolescent cohort, one death was attributed to suspected sepsis in a patient with type 1 diabetes who had multiple complications after a hypoglycemic episode 3 years after surgery, and features of the other two deaths in adolescents, both of which occurred 4 years after surgery, were consistent with overdose (acute combined drug toxicity). Among the adults, three died of early complications of surgery, one died of colon cancer, one of suicide, and the cause of death in the two remaining cases was unclear.
Adolescents experienced a greater rate of abdominal reoperations than the adults (19 vs. 10 reoperations per 500 person-years). As a possible explanation for this, the authors offer: “…closer monitoring for complications in adolescent patients and the potential for a lower threshold to reoperate for suspected complications in younger patients, which would lead to the capture of more events.” Nutritional deficiencies were slightly more common in adolescents compared to adults, which the authors attribute to less compliance with recommended nutritional supplements.
While 5-years of follow up may not seem particularly long, it is important to note that this occurs at a critical stage of development for adolescents and can potentially change the life-trajectories of these kids. Nevertheless, decisions to proceed with bariatric surgery in adolescents should be made on a case-by-case basis, carefully weighing the pros and cons for each case.