Background
Bariatric surgery is the most effective intervention for severe pediatric obesity, but 25% of youth experience suboptimal weight loss and/or weight regain. A multi-pronged postoperative approach, including early re-initiation of anti-obesity medications (AOM), may improve outcomes, though this has not been evaluated in pediatric populations.
Methods
This pilot study assessed the safety, tolerability, and efficacy of early AOM re-initiation after laparoscopic sleeve gastrectomy (LSG) in youth. A retrospective analysis compared youth undergoing LSG at a large children's hospital from November 2023 to July 2024, comparing those who chose early AOM re-initiation (n = 25) versus standard care (n = 21). Primary outcomes included changes in weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions.
Results
The study involved 46 adolescents (mean age 16.5 years, mean BMI 50 kg/m², predominantly female (70%), Hispanic (80%), and publicly insured (87%); 93% had used AOM preoperatively). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, revealed that early AOM re-initiation (5.1 weeks [IQR 3.7,8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6 months postoperatively compared to standard care, with no significant differences in complications or readmissions. At 6 months, the mean differences were: %BMI: -6.5% (95%CI: -9.13, -3.86), p < 0.001; %TWL: -5.9% (95%CI: -8.52, -3.25), p < 0.001; %EWL: -8.2 (95%CI: -14.69, -1.63), p < 0.001. Early re-initiators reported a 4-fold reduction in emotional overeating (p = 0.001) compared to standard care.
Conclusion
Early AOM re-initiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates.
