Adolescent weight-loss surgery on the rise in the U.S. despite availability of new medications

Key Takeaways:

• Weight-loss surgery for adolescents in the United States increased by 15% between 2021 and 2023, even after the approval of new, effective weight-loss medications.
• The study highlights a significant rise in surgery among Hispanic and non-Hispanic Black adolescents, groups disproportionately affected by severe obesity.
• Limited insurance coverage for new weight-loss medications may be influencing the sustained growth in surgery rates despite alternative treatment options.

Significant Rise in Adolescent Weight-Loss Surgery

A recent study led by researchers at UT Southwestern Medical Center has revealed a 15% increase in weight-loss surgeries for adolescents in the United States between 2021 and 2023. The findings, published in The Journal of Pediatrics, provide crucial insights into how severe obesity is being managed among teenagers, a demographic in which this condition is increasing most rapidly.

“The number of U.S. adolescents having access to this treatment that we know is safe and effective is the highest it’s ever been, and hopefully it’s the start of a positive weight loss journey that will get them to better health,” stated Sarah Messiah, Ph.D., M.P.H., Professor of Epidemiology and Associate Dean for Research in the Peter O’Donnell Jr. School of Public Health. Dr. Messiah also serves as Professor of Paediatrics and Director of the Child and Adolescent Population Health Program at UT Southwestern. She co-led the study alongside Sarah Barlow, M.D., M.P.H., Professor of Paediatrics at UT Southwestern.

The Burden of Severe Obesity in Adolescents

In 2018, the combined prevalence of Class II and Class III obesity among U.S. adolescents stood at 9.1%. Severe obesity in young people is linked to numerous health complications, including cardiovascular disease, liver and kidney disorders, obstructive sleep apnoea, and mental health challenges.

Surgery and Medication: Complementary Treatment Options

Metabolic and bariatric surgery (MBS)—which includes procedures such as gastric sleeve, gastric band, and gastric bypass—remains the gold standard for sustained weight reduction and the mitigation of obesity-related health risks in both adolescents and adults. Recently, however, a new class of weight-loss medications known as glucagon-like peptide-1 receptor agonists (GLP-1RAs) has gained substantial popularity. Semaglutide, a notable example, received approval from the U.S. Food and Drug Administration (FDA) for adults in June 2021 and for adolescents in December 2022.

These medications assist individuals in achieving a reduction of 15%–20% of their baseline body weight, offering a non-invasive alternative to surgical interventions. However, Dr. Messiah emphasised that these medications are not yet covered by Medicaid for obesity treatment in the majority of states, including Texas. Coverage by private insurers also remains limited, making these treatments financially inaccessible for many families.

Analysing National Trends in Bariatric Surgery

To better understand trends in MBS amidst the growing availability of weight-loss medications, the research team utilised data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use files. This extensive database contains records from nearly 1,000 accredited medical centres in the United States that perform MBS. The researchers analysed data on adolescents aged 13 to 19, as well as adult patients, who underwent MBS between 2021 and 2023—spanning the period before, during, and after GLP-1RAs were approved for adolescent use. They also examined demographic characteristics of the patients.

Their analysis revealed that adolescent MBS rose from 1,376 procedures in 2021 to 1,581 in 2023. The mean age of adolescent patients undergoing surgery decreased slightly, from 17.91 to 17.79 years. The gastric sleeve was by far the most common procedure, accounting for over 86% of all surgeries.

Among adults, MBS rose from 209,829 procedures in 2021 to 229,159 in 2022 but declined to 216,323 in 2023. The researchers hypothesised that this decline may be attributed to more adults opting for GLP-1RA medications rather than surgery.

Addressing Disparities and Opportunities for Earlier Intervention

This study is the first to demonstrate that a significant portion of the rise in adolescent MBS was driven by increases among Hispanic and non-Hispanic Black young people. These groups are disproportionately affected by severe obesity in comparison to their non-Hispanic white peers. Dr. Messiah noted a concerning finding that approximately one-third of adolescents undergoing MBS had a body mass index (BMI) exceeding 50. She highlighted that earlier intervention with MBS could have supported these individuals in reducing their BMI at younger ages, thereby lessening their long-term health risks.

“Severe obesity is very common, much more common than it should be, and it is unlikely to respond to lifestyle interventions alone. I think the relative number of bariatric surgeries is still pretty low, given the potential benefit and need among kids,” said Dr. Barlow.

A Combined Approach for the Future

Looking ahead, the researchers anticipate that effective treatment for severe obesity will increasingly involve a combination of MBS, weight-loss medications, and lifestyle interventions to support sustained improvements in health.

Acknowledgements and Funding

The study’s co-authors included Faisal Qureshi, M.D., M.B.A., Professor of Paediatrics and Surgery; Alicia Wheelington, Ph.D., Assistant Professor of Psychiatry; Bethany Cartwright, M.D., Ph.D., Assistant Professor of Paediatrics; Benjamin Schneider, M.D., Professor of Surgery and Chief of the Division of Bariatric and Foregut Surgery; Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine and in the O’Donnell School of Public Health; Jaime Almandoz, M.D., M.B.A., Associate Professor of Internal Medicine; M. Sunil Mathew, M.S., Senior Population Science Data Manager; and Jackson M. Francis, M.P.H., Population Science Project Coordinator.

This research was funded by a grant from the National Institute of Child Health and Human Development (R21HD105129).