Severely obese adolescents lost weight, kept it off, and removed comorbidities after bariatric surgery

According to researchers from UTHealth Houston and the University of Miami, severely obese adolescents who underwent bariatric surgery before age 22 had significant and lasting weight loss and comorbidities after surgery.

The results of the study were published early online in the Journal of the American College of Surgeons.

The study contains the longest follow-up data currently available on adolescents who are severely obese after weight-loss surgery, showing they lost 31.3% of their weight and kept it off more than a decade later. They also had a 100% remission in diabetes, asthma and elevated lipids.

“There are long-term benefits to completing bariatric surgery before age 22,” says Sarah Messiah, PhD, MPH, senior author of the study and professor and director of the Center for Pediatric Population Health at the UTHealth School of Public Health-Dallas . “The sustainability of the positive health outcomes is not yet well known at this young age. It is a gap in understanding that this research has helped to fill.”

Messiah has collaborated with lead author and bariatric surgeon Nestor de la Cruz-Munoz, MD, at the University of Miami for 15 years, to research the outcomes of bariatric surgery for adolescents.

“It’s like a deep sigh of relief to see results that confirm that we’ve been doing good for these patients for 20 years, even if they were lost to follow-up,” de la Cruz-Munoz said. “Some of these kids are severely depressed, and if we can change the lives of these kids while they’re in high school or before college, it can give them a fresh start and hope for a better life.”

While many patients in the study were lost to the bariatric team due to problems with insurance coverage or relocations, the study results showed they were followed by pediatricians and primary care physicians for health conditions, and complications were rare.

“What sets this study apart is that 74% of patients who have had surgery are Hispanic and 84% are Hispanic or non-Hispanic Black. We know that minority groups are disproportionately affected by obesity, and this shows that they have benefited from the surgery, and so surgery can be a tool to address these inequalities,” Messiah said.

In the US, nearly 12% of non-Hispanic black adolescents, 9% of Hispanic adolescents and 7% of non-Hispanic white adolescents aged 12 to 19 are severely obese, meaning a body mass index (BMI) percentile is equal to or higher than the 99th percentile for their age and gender. This puts them at greater risk of developing cancer and chronic diseases, including cardiovascular disease, diabetes, kidney disease, and liver disease.

Of the 96 respondents who took part in the study, 86.5% reported improved dietary habits since surgery, 60.4% were involved in regular exercise, and more than half of the women, 67%, had a successful pregnancy and delivery.

Patients’ BMI numbers fell from 44.9 before surgery to their lowest BMI of 25.2 after surgery, a 44.4% decrease.

Prior to surgery, 14.6% of patients had hyperlipidemia (high levels of fat in the blood), 10.4% had asthma, and 5.2% had diabetes or hyperglycemia. After surgery, the remission was 100%. Hypertension, sleep apnea, anxiety, gastroesophageal reflux disease and depression also decreased significantly.

“Adolescents are the fastest growing segment of the severe obesity epidemic in the US, and the COVID-19 pandemic has exacerbated the problem,” Messiah said. “The evidence from this study supports recent recommendations from the American Academy of Pediatrics to increase access to surgery for adolescents. We hope this data can change the barriers to entry for these children.”

UTHealth School of Public Health co-authors were Luyu Xie, PharmD, PhD; Folefac Atem, PhD; and M. Sunil Mathew, MSIT. Other co-authors were Hallie J. Quiroz, MD; and Onur C. Kutlu, MD, of the University of Miami; and Steven E. Lipshultz, MD, of the University at Buffalo.

Funding came in part from grants from the National Institute on Minority Health and Health Disparities of the National Institutes of Health.

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