Metabolic and bariatric surgery

Abstract

As far as the Archivist goes, bariatric surgery in children and young adults to ‘treat’ extreme weight, remains controversial; especially if completed before puberty and final adult height has been achieved. In the adult world, it appears that metabolic and bariatric surgery (MBS) is an effective, acceptable treatment of severe obesity and is a recommended intervention on most adult guidelines. What about the risks and benefits in young teenagers compared with older adolescents? Ogle SB et al [Pediatrics 2021;147:e2020024182; DOI: https:// doi. org/ 10. 1542/ peds. 2020024182] have reported a non controlled, non randomised, observational study in USA, comparing weight loss, comorbidity resolution, nutritional abstract abnormalities, and quality of life between younger and older adolescents after MBS. From March 2007 to December 2011, 242, young adults who underwent bariatric surgery at these five centres were included in this prospective, multicentre, longterm outcome study; Teen–Longitudinal Assessment of Bariatric Surgery (TEENLABS). They compared percent BMI change, comorbidity outcomes (hypertension, dyslipidaemia, and type two diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery in 66 young adults aged 13–15 years and compared with 162 older young adults 16–19 years. They demonstrated that younger and older adolescents had similar weight loss, resolution of hypertension and dyslipidaemia, nutritional deficiencies, and improvement in quality of life after surgery and conclude that age alone should not dissuade providers and patients from pursuing surgery when medically indicated. The young adults baseline characteristics, except for age, between the two cohorts were similar. No significant differences in frequency of remission of hypertension or dyslipidaemia were observed between age groups. Remission of type two diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; p=0.046). Weight loss and quality of life were similar in the two age groups. Younger adolescents were less likely to develop elevated transferrin and low vitamin D levels. These authors claim that MBS currently represents the most effective and durable, yet underused, treatment of severe obesity and complications of obesity in thoughtfully selected children. They conclude that their data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone. Jaklevic MC has published a very interesting commentary [JAMA. Published online May 20, 2021. doi:10.1001/jama.2021.7912] focussing on ‘The Push for Earlier Bariatric Surgery for Adolescents With Severe Obesity’. The Archivist still remains unconvinced with concern about safety, effect on growth and puberty, psychological impact, ethical concerns with patient assent, and parents pushing a child into the surgery, and compliance with postoperative instructions. There are very few data on longterm outcomes. MBS needs careful randomised controlled longterm studies with nonsurgery for comparison. As the prevalence of this surgery increases these data will be harder to collect.