Commentary by Thomas Inge, MD, PhD; Michael A. Helmrath, MD; and Stavra Xanthakos, MD
“This study shows that at 3 years, almost 90% experienced clinically meaningful weight loss, and participants were in better health, with improved quality of life scores,” said lead author Thomas Inge, MD, PhD, Surgical Director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center.
Large Multicenter Study
The multicenter clinical study enrolled 242 adolescents (ages 13 to 19; 75% female) all of whom were severely obese (average weight presurgery, 325 pounds). The participants had an average body mass index (BMI) of 53 kg/m2. The patients underwent Roux-en-Y gastric bypass (n=161) or sleeve gastrectomy (n=67).
Three years after surgery, mean weight reduction in the overall group was 41 kg, and the mean percent weight loss was 27% (28% with gastric bypass and 26% with sleeve gastrectomy). One-quarter of the patients were no longer obese at 3 years.
To view Dr. Inge's brief video about the study, please click here.
Reversal in Diabetes Found in 95% of Adolescents After Bariatric Surgery
Reversal of type 2 diabetes was seen in 19 of the 20 patients (95%) who had follow-up data that could be evaluated. Remission of prediabetes occurred in 13 of the 19 patients (76%). In addition, abnormal kidney function resolved in 86% of the overall group, hypertension normalized in 74%, and lipid abnormalities reversed in 66%.
“The remission rates for medical conditions such as diabetes and hypertension are greater than those we see in many studies of adults who had long-standing obesity before bariatric surgery. It is possible that earlier intervention could lead to better outcomes,” Dr. Inge said. “If sustained, the improvements seen in weight, blood sugar, kidney function, blood pressure, and lipid levels may translate into fewer strokes, heart attacks, and other disabilities later in life.”
“We also are learning that once teens have crossed into these extremes of obesity, only 25% of them can achieve weights in the normal range after surgery, and over half of them remain severely obese even after surgery,” said co-author Michael A. Helmrath, MD, Adolescent Bariatric Surgeon at Cincinnati Children’s Hospital Medical Center. “Timing of surgery may prove important.”
Nutritional Deficiencies Found
Low ferritin levels were found in 5% of study participants at baseline and increased significantly to 57% at 3 years (P<0.001). Vitamin B12 levels decreased by 35% in the overall group, with 8% of patients having deficient levels at 3 years. Vitamin A deficiencies in the gastric bypass group increased from 6% at baseline to 16% at 3 years (P=0.008). Vitamin D deficiency was found in 37% of patients at baseline with no significant change found over time.
In addition, 13% of patients required additional abdominal surgery, most commonly gallbladder removal (8%), during the 3-year follow-up period.
“Long-term studies like this one will help pediatricians, and pediatric subspecialists have informed and balanced discussions with teens and their families about anticipated benefits and risks of bariatric surgery, especially important given that so many of us are now routinely caring for severely obese adolescents with significant health problems,” said coauthor Stavra Xanthakos, MD, Pediatric Gastroenterologist at Cincinnati Children’s Hospital Medical Center.
November 19, 2015
Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2015 Nov 6. [Epub ahead of print]