MedicalResearch.com Interview with:
Dr Thomas H. Inge MD
University of Colorado Denver School of Medicine
Aurora, CO 80045
MedicalResearch.com: What is the background for this study?
Response: Gastric bypass surgery helps severely obese teenagers lose weight and keep it off, according to the first long term follow up studies of teenagers who had undergone the procedure 5-12 years earlier. However, the studies show some patients will need further surgery to deal with complications or may develop vitamin deficiencies later in life, according to two studies published in The Lancet Diabetes & Endocrinology.
Severe obesity is classified as having a BMI of 40 or over (around 100 pounds overweight) and affects around 4.6 million children and teenagers in the USA. It causes ill health, poor quality of life and cuts life expectancy.
The studies are the first to look at long-term effects of gastric bypass surgery in teenagers. Until now, it has been unclear how successful the surgery is in the long-term and whether it can lead to complications. Thousands of teenagers are offered surgical treatment each year.
MedicalResearch.com: What are the main findings?
Response: Both papers showed that gastric bypass dramatically reduced the teenagers’ weight and helped them maintain weight loss up to 12 years later. However, surgery was associated with the development of vitamin D, B12 and iron deficiencies, and some of those who had a bypass needed further surgery to deal with complications. While the surgery resulted in dramatic weight loss, many of the teenagers still remained obese despite significant BMI reductions, meaning that earlier intervention may be needed, coupled with lifestyle changes, such as diet and exercise.
In the first paper, researchers studied 58 American teenagers aged between 13 and 21 who were severely obese and had a gastric bypass.
Average BMI was reduced from 59 before surgery to 36 a year after surgery. Eight years later, average BMI was 42, a 17 point reduction equivalent to a loss of 50 kilos per person or a 30% weight reduction. Although the weight loss was significant, almost two-thirds of cases (63%, 36/57) remained very obese (BMI over 35) and only one person became a normal weight (BMI 18.5-25) at follow-up.
The number of teenagers with diabetes dropped from 16% to 2%, those with high cholesterol reduced from 86% to 38%, while the number with high blood pressure decreased from 47% to 17% as a result of the surgery. Some developed low levels of vitamin D (78%, 39/55), B12 (16%, 8/55) and iron (46%, 25/58), which could be a result of lower food consumption or impaired absorption.
Given the long-term weight loss and health benefits that result from the surgery, the researchers note that these benefits outweigh the small and manageable risk of nutritional deficiencies and conclude that it is a safe procedure for severely obese teenagers.
“Weight loss is crucial for severely obese patients who face poor health and shorter lifespans,” said lead author Dr Thomas Inge, incoming member of the surgical faculty at University of Colorado, Denver, who will direct the adolescent bariatric program at the Children’s Hospital of Colorado. “These two manuscripts clearly document long term benefits of adolescent bariatric treatment, but also highlight several nutritional risks. Now it is important to focus on delivery of the substantial health advantages of surgery while minimizing these risks. Since there are currently two effective bariatric procedures, namely gastric bypass and vertical sleeve gastrectomy, we are currently examining the outcomes of both procedures to determine what is best for adolescents.”
The second study included 81 obese teenagers (average BMI 45) and 81 adults (average BMI 43) in Sweden who had a gastric bypass and 80 teenagers who did not have surgery.
Five years after surgery, the teenagers and adults who had a gastric bypass had a reduced BMI (by 13 points for teenagers, a weight reduction of 28%; 12 points for adults), whereas teenagers who did not have surgery experienced a 7% gain in weight.
Of the teenagers who underwent gastric bypass, some had further surgery to treat complications of the bypass including bowel obstruction (14%, 11/81 cases) or to treat gallstones (11%, 9/81 cases).
Despite the additional care and resources needed to offer the surgery, overall, the cost of care for teenagers who had surgery did not differ ($2317 and $2701). In addition, a quarter of those in the control group (20 of 80) went on to have a gastric bypass as an adult during the study follow-up.
MedicalResearch.com: What should readers take away from your report?
Response: Importantly, non-surgical treatment was directly compared to surgical treatment in this study. “Gastric bypass resulted in substantial weight loss and reduction in cardiovascular and metabolic problems, while improving long term quality of life for severely obese teenagers. While some patients may face complications, those given non-surgical treatment often continue to put on weight, putting them at higher risk of poor health throughout life,” said lead author Dr Torsten Olbers, University of Gothenburg, Sahlgrenska University Hospital, Sweden. “To reduce risk of complication it’s important that gastric bypass for teenagers is done in centres that can provide the full care needed and long-term follow-up and support.”
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Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis
Inge, Thomas H et al.
The Lancet Diabetes & Endocrinology , Volume 0 , Issue 0 ,
Published:05 January 2017
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