Weight Loss After Bariatric Surgery in Teens Persisted at 10 Years

For adolescents, weight loss after bariatric surgery was durable out to 10 years, data from the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study confirmed.

Among 260 adolescents who underwent bariatric surgery, the mean change in body mass index (BMI) was -20% (95% CI -22.9 to -17.1, P<0.001) at 10 years, reported Justin R. Ryder, PhD, of the Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues.

The changes in BMI were similar for the patients who underwent gastric bypass (mean change -20.6%, 95% CI -24.8 to -16.4) or sleeve gastrectomy (mean change -19.2%, 95% CI -24.8 to -13.5), they wrote in a New England Journal of Medicine correspondence.

Beyond durable weight loss, remission of coexisting conditions was also maintained at 10 years, including for 55% of patients with type 2 diabetes, 57% of those with hypertension, and 54% of those with dyslipidemia.

Putting this into perspective, the percentage of participants with remission of type 2 diabetes at 10 years “far exceeded the 18% and 12% reported among adults at 7 and 12 years, respectively, in a recent multicenter randomized, controlled trial,” the researchers noted.

“These data support recent guidance [from the American Academy of Pediatrics] for surgical treatment for adolescents with severe obesity,” Ryder’s group noted. “Given the recent use of effective anti-obesity medications, it is imperative to directly study the relative efficacy and risks of medical and surgical treatment approaches — both of which hold promise to improve the lives and health of adolescents with severe obesity.”

According to a recent study, the number of adolescents and young adults prescribed a GLP-1 receptor agonist increased nearly 600% over the past few years, with liraglutide (Saxenda) and semaglutide (Wegovy) both approved for weight management in pediatric patients.

Ryder told MedPage Today that this “is the longest adolescent bariatric surgery follow-up study, with prior studies being 5 years or less.” Though he said he was not surprised by the findings, “it was nice to see adolescent bariatric surgery be an outstanding treatment option out to 10 years,” he noted.

“Adolescent bariatric surgery is a safe, effective, and durable treatment option for youth with severe obesity,” he added. “Pediatricians and providers who treat adolescents with severe obesity should consider referring these patients to children’s hospitals with bariatric surgery expertise.”

The Teen-LABS study enrolled adolescents ages 13 to 19 who underwent either gastric bypass (161 participants) or sleeve gastrectomy (99 participants) at a mean age of 17 years. Overall, 83% of the 10-year postoperative visits were completed.

Looking at weight loss trends, the researchers identified four distinct BMI trajectories in the years after surgery:

• One that reached a nadir at month 6, then increased, with a 10-year change from baseline of +7.1%
• One that reached a nadir after 1 year, then increased, with a 10-year change from baseline of -12.6%
• One that also reached a nadir after 1 year, then stayed the same, with a 10-year change from baseline of -26.9%
• One that reached a nadir around year 5 and stayed the same, with a 10-year change from baseline of -43.7%

Cumulative logistic modeling showed that greater early weight loss (measured as the change in BMI at 6 months) was associated with a more favorable long-term BMI trajectory (OR 1.16, 95% CI 1.11-1.21).

Some limitations to the study included its observational design, the small sample size for certain coexisting conditions, and the lack of a contemporaneous nonsurgical control group.

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