Should bariatric surgery be performed in adolescents?

Abstract

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?

“…Only one 30-day mortality has been reported in more than 750 cases compared to an incidence of 0.08–0.31 in adult studies. Reporting of ‘minor complications’ and additional operations appeared to be higher in adolescent studies compared to adult series with 13–17% requiring additional operations as compared to 6–7% in adult cohorts [ 57 •].…”

Current Opinions and Practices of Bariatric Surgery in Adolescents: A Survey among Pediatric Surgeons

“…8 Bariatric surgery is considered safe and effective by many to obtain substantial weight loss and resolution of associated comorbidities. 9,10 Despite the favorable results of bariatric surgery in the literature, implementation of this treatment shows a large variety worldwide. While numbers of severely obese adolescents undergoing bariatric surgery in the United States are increasing, surgeons in Europe seem more reluctant to perform such procedures.…”

Excellent Short- and Medium-term Result of Bariatric Surgery in Adolescence. A Single Center Study

“…It is true that prevention is the mainstay in the fight against obesity and this means to encourage a healthy lifestyle with constant balanced diet and moderate physical activity. Still, the intense application of nonsurgical treatment modalities -radical behavior shift and diet change -in the obese and extremely obese adolescents has only proven to have unsatisfactory and short term results, while bariatric and metabolic surgery emerges as the most effective treatment option (6,7,8,9).…”