Background: Following years of dietary and lifestyle intervention (DLI) as the only therapeutic option, reports of bariatric surgery are emerging in adolescents with morbid obesity. We present herein preliminary results of our 4-yr sleeve gastrectomy study.
Objectives and hypotheses: To compare the effects of laparoscopic sleeve gastrectomy (LSG) and intensive DLI in adolescents with morbid obesity (ie BMI >4 DS) and extremely active weight gain (i.e. >0.6 kg/month).
Patients: 45 patients (mean age 17.3±1.6 years, BMI 45.5±8.4; z-score 4.6±0.8) underwent LSG and were followed for 25±12 months (648 months) while a control group of 100 patients received intensive DLI (mean age 15.5±1.9 years; BMI 38±4; z-score +4.4±0.6). LSG was systematically preceded by a 12-month period of intensive DLI. Insulin resistance (IR) was estimated using HOMA-IR.
Results: Patients who underwent LSG lost 33.2±8.2% of their initial body weight (98±2% of excess body weight) i.e. a total of 40.4±5 kg over the whole period of observation: 29.6±8.7% one year post-surgery (−3±0.6 kg/mo); 30.2±6.5% at the end of the 2nd year (−0.6±0.2 kg/month) and 33.3% (−0.41±0.2 kg/month) at the end of the 3rd year. In comparison, the control group lost little weight (0.5±0.3 kg/month) and only in the 1st year, a rate observed in patients the year before LSG (0.6±0.4 kg/month) and after the 1st post-surgical year. Durable improvement of IR, glucose tolerance, serum lipids, arterial pressure, QoL were observed in all patients following LSG, but did not correlate with the magnitude of weight loss.
Conclusion: While classical LDI had almost no effect on severe obesity in morbidly obese adolescents, preliminary results support important and durable benefits of LSG.
10 Sep 2016 - 12 Sep 2016