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

Abstract

BackgroundSevere obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are limited, while short-term outcomes of adolescent bariatric surgery are promising. This study aimed to report 5-year outcomes following Roux-en-Y gastric bypass (RYGB) in adolescents, compared with conservatively treated adolescents and adults undergoing RYGB.MethodsA nationwide prospective non-randomised controlled study of adolescents (13–18 years) with severe obesity undergoing RYGB, a matched adolescent control group undergoing conservative treatment, and an adult comparison group undergoing RYGB. The primary outcome measure was change in weight over 5 years. Multilevel mixed-effect regression models were used to assess longitudinal changes. Healthcare usage was analysed with linear regression together with nonparametric bootstrapping.FindingsEighty-one adolescents with baseline age 16·5 years (SD 1·2), weight 132·8 kg (SD 22·1) and body mass index (BMI) 45·5 kg/m2 (SD 6·1) underwent RYGB. Five-year weight change was −36·8 kg (95% CI −40·9 to −32·8) resulting in a BMI reduction of 13·1 kg/m2, although weight loss <10% occurred in 11%.Comorbidities and cardiovascular risk factors resolved in 74–100%: type 2 diabetes (3/3), disturbed glucose homeostasis (18/21), dyslipidaemia (43/52), elevated blood pressure (11/12), inflammation (hs-CRP ≥ 2 mg/L; 45/61) and elevated liver enzymes (19/19), each comparing favourably with adolescent controls at 5 years.Functional (SF-36) and obesity-specific (OP-14) quality of life improved in the adolescent RYGB group (mean difference 4·2, p=0·006 and −9·9 p=0·009). Twenty RYGB participants (25%) underwent additional abdominal surgery for complications of surgery or rapid weight loss, 72% demonstrated some nutritional deficiency, and healthcare consumption increased. Mean BMI increased in control adolescents (3·3 kg/m2, 95% CI 1·9 to 4·8), while BMI change in adults was similar to surgical adolescents (mean difference 0·8 kg/m2, 95% CI −1·1 to 2·8). Twenty adolescent controls (25%) underwent bariatric surgery within 5 years.InterpretationAdolescents with severe obesity undergoing RYGB experienced substantial weight loss over 5 years, alongside improvements in comorbidities, risk factors and quality of life. Surgical intervention was, however, associated with additional surgical interventions and nutritional deficiencies. Non-surgical treatment was associated with weight gain and 25% underwent bariatric surgery within 5 years.

Burden of child and adolescent obesity on health services in England

“…Yet the evidence suggests that community multicomponent interventions have useful effects17 and that bariatric surgery is safe and highly effective in adolescents 1819…”

Changes in inflammatory markers correlated with increased testosterone after laparoscopic sleeve gastrectomy in obese Chinese men with acanthosis nigricans

“…Bariatric surgery is the most effective treatment option for severe obesity and its associated comorbidities . Zhang et al .…”

Prevention Models of Childhood Obesity in Sweden

“…But we need long-lasting results in children to be able to state that we have prevented adult obesity. Surgical treatment might give a long-lasting result until adulthood [4]. …”