Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

Stanford, Fatima Cody; Mushannen, Tasnim; Cortez, Priscilla; Reyes, Karen J. Campoverde; Lee, Hang; Gee, Denise W.; Pratt, Janey; Boepple, Paul A.; Bredella, Miriam A.; Misra, Madhusmita; Singhal, Vibha

doi:10.3389/fendo.2020.00157

Cited by 42 publications

(15 citation statements)

References 24 publications

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“…Bariatric surgery has gained popularity since the early 2000s in the management of severe obesity. If performed earlier, there are better outcomes for reducing weight and resolving obesity-related comorbidities in adults ( 179 – 182 ). Currently, the indication for bariatric in adolescents; those who have a BMI >35 with at least one severe comorbidity (Type 2 Diabetes, severe OSA, pseudotumor cerebri or severe steatohepatitis); or BMI of 40 or more with other comorbidities (hypertension, hyperlipidemia, mild OSA, insulin resistance or glucose intolerance or impaired quality of life due to weight).…”

Section: Treatmentmentioning

confidence: 99%

Childhood and Adolescent Obesity: A Review

2021

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Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of “being healthy.” To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.

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Section: Treatmentmentioning

confidence: 99%

Childhood and Adolescent Obesity: A Review

2021

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“…The rise of obesity over the past 30 years, especially with high rates of severe obesity in children living in non-metropolitan areas (11), calls for more aggressive combination therapies that include behavioral modification, medications, and surgical interventions (12,13). According to the most recently available data from the NHANES, the prevalence of severe obesity from 2015 to 2016 was 1.9% among children and adolescents 2 to 19 years old, with 4.5% of adolescents age 16-19 years old affected by severe obesity (1).…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

et al. 2020

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Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m 2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ∼6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m 2 , respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should Czepiel et al. Pharmacotherapy for Weight Reduction in Pediatrics be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.

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“…However, many surgeons are still reluctant to embrace bariatric surgery in adolescent patients; they state that it is irreversible, invasive, and has potential life-long alterations [ 64 ]. Arguments in favor of an early surgical approach are based on the evidence that the efficacy of surgery is reduced over time and that adolescent obesity is more intractable and sustained than obesity in adults [ 66 , 67 ]. The recent American Society of Metabolic and Bariatric Surgery (ASMBS) guidelines outline the inclusion criteria for pediatric and adolescent bariatric surgery; with the significant improvement in long term data, they are less controversial than previous guidelines which often presented ethical concerns and scarcity of long-term data [ 58 , 68 ].…”

Section: Eligibility Criteria For Bariatric Surgerymentioning

confidence: 99%

“…A recent study that evaluated weight loss up to four years after VSG showed greater benefits in adolescents than in adults with T2D resolution after MBS (both VSG and RYGB) in 87% of adolescents versus 54% of adults [ 67 ], therefore suggesting strong advantages of early surgery.…”

Section: Weight Loss and Resolution Of The Metabolic Comorbiditiesmentioning

confidence: 99%

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Bariatric Surgery in Adolescents: To Do or Not to Do?

et al. 2021

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Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

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Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

Cited by 42 publications

References 24 publications

Childhood and Adolescent Obesity: A Review

Childhood and Adolescent Obesity: A Review

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

Bariatric Surgery in Adolescents: To Do or Not to Do?

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