Weight Loss Surgery Safe and Effective in Children, Adolescents
at 10-Year Follow-Up
Results from a 10-year study of children and adolescents who underwent a common weight loss surgery to treat severe obesity show they safely have long-lasting major weight loss and improvement of their obesity-related medical problems without stunting their growth in height. The study, involving the longest known follow-up of pediatric patients after laparoscopic sleeve gastrectomy, is published in the Journal of the American College of Surgeons.
Insufficient information existed on results of this weight loss surgery in children and adolescents beyond five years, according to study authors from Saudi Arabia, where the research occurred. Also called the gastric sleeve procedure, sleeve gastrectomy is now more popular than gastric bypass because of lower complication rates.
During this surgery, surgeons divide and remove part of the stomach, leaving the remaining stapled portions to create a “sleeve” in the form of a banana-sized stomach. This smaller tubelike new stomach enables patients to eat less food and lose weight. It’s also effective because surgeons remove the part of the stomach containing the “hunger” hormone that stimulates appetite.
“Lack of long-term data and some pediatricians’ fears that bariatric surgery might affect children’s linear growth has led to worldwide resistance to performing weight loss procedures for children below 14 or 15 years of age,” says principal author Aayed R. Alqahtani, MD, FACS, FRCSC, a professor of bariatric and minimally invasive surgery at King Saud University and CEO of New You Medical Center in Riyadh, Saudi Arabia.
Their long-term study results showed that patients lost nearly 30% of their total weight, on average, and had widespread reversal of type 2 diabetes and key heart disease risk factors, with no procedure-related deaths or major complications, according to Alqahtani.
“Our findings present clear evidence that should remove hesitance to perform bariatric surgical treatment in children and young adolescents who could benefit from the operation,” he says. “We have a proven solution for severe obesity and its comorbidities.”
This study is the largest of its kind to date in this age group, with more than 2,500 participants aged 5 to 21, Alqahtani says. Nearly one-third were younger than 15 at the time of their surgery, which he says is younger than in many US studies.
All patients had severe obesity, which is defined as a weight at least 120% of the 95th percentile for age and sex on the Centers for Disease Control and Prevention’s growth charts. The patients reportedly had been unable to lose substantial weight despite a six-month weight loss program involving dietary and behavioral counseling.
Between 2008 and 2021, the patients underwent sleeve gastrectomy. Before the surgery, approximately 1 in 10 patients had type 2 diabetes or abnormal blood lipid levels. High blood pressure was even more prevalent, occurring in 15% of these young patients. Obesity, which affects 18.5% of US youth, raises the risk of these serious medical conditions and others including fatty liver disease, sleep apnea, and depression.
The pediatric patients continued to have good results seven to 10 years after the surgery, including the following:
• They maintained an average 71% loss of excess weight.
• Type 2 diabetes resolved in more than seven of every 10 affected patients.
• Lipids and blood pressure became normal in more than 57% of patients who previously had abnormal lipids and high blood pressure, both risk factors for heart disease.
Because many of the patients hadn’t yet reached their full adult height, the researchers could compare growth velocity—the speed of growth in height—between younger and older pediatric patients. They found growth velocity was unaffected and didn’t differ between patients 14 or younger vs those older than 14.
The researchers’ findings correspond with current scientific evidence recommending early surgical intervention, Alqahtani says. The most recent guidelines from the American Academy of Pediatrics and the American Society for Metabolic and Bariatric Surgery don’t advise waiting until a child reaches maturity if the surgery is recommended for the child based on their weight and obesity-related diseases.
“If you surgically intervene early, you can cure children’s obesity-related diseases early and improve their quality of life, and if you wait longer, their diseases might become irreversible,” Alqahtani says.
Alqahtani attributed the study’s results to factors including the following:
• The surgeon used differences in the gastric sleeve they created, which he believes made it less likely to regain weight.
• Patients had permanent access to follow-up care and phone contact with the surgical and medical team.
• The patient’s family helped ensure their child’s adherence to postsurgery operative recommendations.
Another strength of the study, Alqahtani says, is their patient population had a more even sex-based distribution than previous studies. Girls are more likely than boys to undergo weight-loss surgery, but male patients comprised 45% of their sample.
— Source: American College of Surgeons