Roux-en-Y gastric bypass surgery, or gastric bypass surgery, is safe and effective to keep weight off for a long time in morbidly obese teenagers and young adults – says a new FABS-5+ University of Colorado Denver School of Medicine Study.
“Over the past decade, increasing numbers of adolescents are seeking surgical treatment, because surgery has shown effectiveness in adults,” said Dr. Thomas Inge, M.D. of Cincinnati Children’s Hospital Medical Center and the lead author of the study. “Standard treatment does, unfortunately, fail with most, if not all, teenagers who are severely obese.”
Obesity, defined as body mass index of (BMI) ≥30 kg/m2, has become an epidemic of global proportions. Recent years have seen a shocking surge in childhood and adolescent obesity both in the United States and rest of the world. In the US, the count has almost quadrupled in last three decades – from 5% to 21%.
Obese children and adolescents are not only likely to grow into obese adults but are at a greater risk of type 2 diabetes mellitus (T2DM), sleep apnea, bone disease, psychological maladies, cancers, hypertension, nonalcoholic fatty liver disease (NAFLD), and cardiovascular disease. Evidence shows that 70% of the obese youth are likely to get premature heart disease.
However, last few decades have seen a fair recognition of obesity dispelling the belief that the condition is “self-inflicted”. While fairly common amongst adults, weight loss surgery procedures, such as Roux-en-Y gastric bypass surgery, sleeve surgery and band-aid surgery, are rarely performed in adolescents in the United States.
Researchers followed a cohort of 58 teenagers ages 13-21 years who underwent Roux-en-Y gastric bypass between 2001-2007 to assess safety and efficacy of the surgery and whether it helps stave off complications of surgery and obesity in the long run. The follow up comprised 5-12 years.
Bariatric surgery successfully put off weight in such individuals, reducing average BMI from 58·5 kg/m2 at baseline to 41·7 kg/m2 after 8 years. Significant declines were observed in vital signs and other obesity-linked complications such as high blood pressure dyslipidemia, and risk of type 2 diabetes.
Researchers concluded gastric bypass surgery to be safe, effective and durable in reducing weight and cardiometabolic complications in morbidly obese adolescents. Experts recommend that adolescents who qualify for a bariatric surgery should have a BMI ≥35 kg/m2 and have at least one comorbidity severe enough to affect their well-being and quality of life such as sleep apnea, T2DM, increased pressure around brain (pseudotumor cerebri), or severe fatty liver disease (steatohepatitis). Teens with a BMI ≥40 and a minor comorbidity also qualify for bariatric surgery.
The study was published in The Lancet Diabetes & Endocrinology on January 5th, 2017.
Obstacles To Bariatric Surgery In Adolescents
A variety of barriers such as lack of resources, prejudice, the notion that obesity is self-inflection and policies placing heavy emphasis to bring about lifestyle changes, preclude adolescents from considering bariatric surgery as a viable option. In fact, there are currently no recommendations on weight loss surgery for children and young teens.
Post-surgical complications after bariatric surgery procedures are another hurdle. For one, in the current study, despite reducing BMI, two-third of the teens remained obese during follow-up. For another, post-surgical complications such as gastrointestinal problems, such as food intolerance, leaky gut, leak at the staple line, infections, small bowel obstruction, fistula, and pulmonary embolism among others have been reported.
Unsurprisingly, doctors see patients complaining of post-surgical complications, particularly those who have not been provided a proper follow-up or durable support. These patients are also at the long-term risk of reduced bone density and vitamin B, vitamin D, thiamine and iron deficiency.
Despite the complications of bariatric surgery, it is a well-known fact that lifestyle modifications do not provide a sustainable weight loss in morbidly obese teens. The sheer lack, and sometimes failure, of non-surgical options and a safety record of bariatric surgery in adults has upped interest in bariatric surgery for adolescents.
The current study is one step to pave way for teens to opt for gastric bypass surgery who have failed other attempts and interventions. The gastric bypass surgery has the potential to prevent obese teens from becoming obese adults. A surgical intervention in early years of life can not only reduce burden of disease but would also prove to be more cost-effective in the long run.
The need of the time is to increase physician training in bariatric surgical procedures for children and adolescents to address the stressed and desperate obese teens failing other measures. Furthermore, discrimination towards obese and insistence on “self-infliction” of obesity also need acknowledgement at clinical and government levels.