Background: Childhood obesity is a serious medical condition where excess body fat negatively affects a childs health. Although prevention is the primary step, there will be obese adolescents who benefit from bariatric surgery. There are four bariatric methods (all using laparoscopic technique): Adjustable Gastric Banding (AGB), Roux-en Y Gastric bypass (RYGB), sleeve gastrectomy and Bilio-Pancreatic Diversion (BPD). In Sweden we predominantly use RYGB as it improves eating behavior, leads to larger weight loss and preserves free fat mass (FFM) compared to other techniques. Today several bariatric surgery studies in adolescent populations (of whom few randomized) are published, but none has 510 year follow-up data.
Objective and hypotheses: The objective was to review the literature of all those major studies that performed bariatric surgery in 1318 year olds with morbid obesity. The hypothesis was that if surgery is performed during adolescent years, a better outcome in terms of weight and health-related quality of life would be obtained, whereas more doubtful effects may be found concerning compliance and bone mineral content due to physical immaturity.
Method: A systematic search was performed in PubMed, EMBASE, PsychINFO, BNI, ProQuest, the Cochrane Library, and a number of HTA-databases. We identified one randomized controlled trial (RCT) and three cohort studies. Seventeen case series were included, of which six dealt with the comparison between adults and adolescents.
Results: The only published RCT has demonstrated that laparoscopic gastric banding is effective in adolescents recruited directly from the community when compared to the best conventional therapy. In contrast, other studies have not been successful with gastric banding in adolescents. Data from the Adolescent Morbid Obesity Study from Sweden show a weight loss (35%) in the same magnitude as found in adults, with substantial improvement of quality of life, preserved FFM but loss of bone mineral density. From the Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational cohort of 242 obese adolescents in US, we know there is a favourable short-term complication profile.
Conclusion: There is a lack of RCTs and long-term data outcomes of bariatric surgery in obese adolescents versus adults.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology