Weight Loss and Health Status Three Years after Bariatric Surgery in Adolescents

Sarah Vo, Mercer University College of Pharmacy

According to the Centers for Disease Control and Prevention (CDC), childhood obesity is a serious problem in the United States.  The CDC reports that about 17% (or 12.7 million) children and adolescents aged two to 19 years are obese in 2011 – 2012.  It is also reported that the prevalence of obesity among children aged two to five years decreased significantly from 13.9% in 2003 – 2004 to 8.4% in 2011 – 2012. [1]

Weight loss surgery or bariatric surgery are considered to be options when regular weight loss attempts have failed and medical problems persist.  One type of surgery is said to include gastric bypass, or Roux-en-Y gastric bypass.  This is said to be the most commonly performed weight loss surgery involving the creation of a small pouch that will serve as the new stomach.  The other type of surgery is said to include gastric sleeve.  It is suggested that this second-most common weight loss procedure involves removing a portion of the stomach and creating a “sleeve” from the remaining portion. [2]

Title: Weight Loss and Health Status Three Years after Bariatric Surgery in Adolescents [3]
Design Prospective, multicenter, observational; N = 242
Objective To report three year change in weight and select health parameters after common bariatric surgical procedures
Study Groups Adolescents (≤ 19 years of age) who are undergoing any bariatric surgical procedure from March 2007 – February 2012
Methods Follow-up data collected at 6-month, 1-year, 2-year, and 3-year postoperative research visits
Duration Unknown
Primary Outcome Measure Changes in body weight, coexisting conditions, micronutrient levels, and weight-related quality of life through three years after the procedure
Baseline Characteristics All participants (n = 228) Gastric bypass (n = 161) Sleeve gastrectomy (n = 67)
Age, year 17 ± 1.6 17 ± 1.5 17 ± 1.7
Age group, number (no.)
13 – 15 years 65 42 24
16 – 17 years 91 71 23
18 – 19 years 72 48 20
Sex, no.
Female 171 126 45
Male 57 35 22
Mean weight – baseline, kg 149 151 144
Mean body mass index (BMI) – baseline, kg/m2 53 54 50
Mean quality-of-life total score at baseline = 63 (95% confidence interval [CI], 61 – 65)
Results Through the three year study end point, 225 of 228 participants completed 88% of all postoperative visits.
Results at three years:
Overall Gastric bypass Sleeve gastrectomy
Mean weight reduction, % 27 (95% CI, 25 – 29) 28 (95% CI, 25 to 30); p < 0.001) 26 (95% CI, 22 to 30; p < 0.001)
Mean BMI reduction, % 28 (95% CI, 30 – 25) 28 (95% CI, 31 – 25) 26 (95% CI, 30 – 22)
Normalized blood pressure, % 74 (95% CI, 64 – 84) 78 (95% CI, 68 – 89) 56 (95% CI, 32 – 81)
Normalized lipid levels, % 66 (95% CI, 57 – 74) 69 (95% CI, 60 – 79) 55 (95% CI, 38 – 72)
Resolution of abnormal kidney function, % 86 (95% CI, 72 – 100) 84 (95% CI, 68 – 100) 100 (95% CI, 100 – 100)
Low ferritin level, % 57 (95% CI, 50 – 65) 65 (95% CI, 57 – 74) 34 (95% CI, 20 – 48)
Low vitamin B12 level, % 8 (95% CI, 4 – 12; p < 0.005) 8 (95% CI, 3 – 13; p < 0.01) 8 (95% CI, 0 – 16)
Diabetes remission, % 95 (95% CI, 85 – 100) 94 (95% CI, 84 – 100) 100 (95% CI, 100 – 100)
Mean quality of life total score 83 (95% CI, 81 – 86)
Adverse Events Common Adverse Events: not reported
Serious Adverse Events: not reported
Percentage that Discontinued due to Adverse Events: not reported
Study Author Conclusions A majority of participants in our study had marked improvements with respect to weight, obesity-related coexisting conditions, and quality of life.  The emergence of specific micronutrient deficiencies and the need for the subsequent abdominal procedure indicate that there are also risks associated with bariatric surgery in this age group.

A strength of the study include the prospective enrollment of consecutive patients at geographically distinct sites, the standardized methods used to collect data, and strong cohort maintenance over time.  A limitation of the study included a small size of certain important subpopulations, such as patients with diabetes.  Also, the observational nature of the study introduces heterogeneity into the data set, including unmeasured covariates and imbalances in race, sex, and socioeconomic status.

Studies that asses the longer-term durability of weight loss, potential improvements with respect to coexisting conditions, the risk of adverse events, and the cost may provide a better understanding of the role of bariatric surgery in the treatment of severe obesity in adolescents.

References

  1. Childhood Obesity Facts. The Centers for Disease Control and Preventionhttp://www.cdc.gov/obesity/data/childhood.html.  Updated June 19, 2015.  Accessed November 11, 2015.
  2. Weight Loss Surgery (Bariatric Surgery). KidsHealthhttp://kidshealth.org/parent/nutrition_center/weight_eating_problems/wlsurgery.html#.  Updated April 2015.  Accessed November 11, 2015.
  3. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416-25.
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