Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality

Abstract

Obesity is a major health problem across all age groups and has escalated to pandemic proportions. The proportion of children with overweight or obesity has risen rapidly over recent decades, and it is recognized that most obese children become obese adults. Furthermore, BMI is the strongest CV risk factor to track from childhood into adulthood. As well as BMI, multiple CV risk factors begin in childhood and strong associations between these factors and BMI are evident. Clear evidence exists for the CV benefits of reversing obesity in adults, much of which examines the effects of bariatric surgery. The capacity of bariatric surgery to reliably achieve safe and lasting improvement in BMI is unparalleled, and the emerging evidence base in adolescent bariatric surgery has so far concurred. In the absence of effective alternatives, it appears that the increase in use of bariatric surgery in adolescents will continue.

Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study

“…Delaying surgery thus represents an avoidable prolongation of exposure to cardiometabolic risk factors, with risk of development or progression of comorbid diseases. 7 …”

“…3,4 As the mean age of obesity onset has decreased, 5 the onset of related diseases, most notably type 2 diabetes (T2DM), has shifted increasingly toward childhood. 6 T2DM is markedly more aggressive when occurring in childhood, 6 and obesity increases cardiovascular risk factors in childhood, 7 leading to a poor prognosis in this group, 8,9 with few effective therapeutic options available. 10 …”

Laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy for teenagers with severe obesity - TEEN-BEST: study protocol of a multicenter randomized controlled trial

“…4 Department of Pediatrics -Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 5 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. 6 Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.…”

“…Obesity is a chronic disease associated with several comorbidities including Type 2 diabetes (T2D), cardiovascular disease (including hypertension and dyslipidemia), musculoskeletal disorders and some cancers [4]. Correlated to the increase in prevalence of childhood obesity, an alarming shift in the onset of these obesity related comorbidities towards childhood has been noted, particularly for T2D [1,[5][6][7][8][9][10]. The timeframe between the onset of T2D and the requirement of insulin therapy is shorter in adolescents than in adults, with medical treatments failing earlier [7,8].…”

“…Additionally, other comorbidities including metabolic disturbances also develop earlier in life [10]. All these factors contribute to a poor prognosis in adolescents with severe obesity, in whom studies have indicated a reduction in life expectancy of almost 20 years [5,11,12].…”