Study finds weight-loss surgery in adolescents leads to major long-term health benefits

A landmark study spanning 18 years and costing $29 million has found that weight-loss surgery in adolescents with severe obesity can lead to long-lasting health improvements, particularly in the remission of type 2 diabetes. The research, funded by the National Institutes of Health (NIH) and published in the New England Journal of Medicine, highlights how surgical interventions in young people bring about more sustained benefits compared to adults who undergo the same procedures.

With a rising prevalence of severe obesity in young people, researchers underscore the need to understand the benefits and risks of medical and surgical options. “These findings are essential as effective treatment options for severe paediatric obesity remain rare,” said Dr Thomas Inge, the study’s principal investigator and surgeon-in-chief at Lurie Children’s Hospital in Chicago. “Robust data on the outcomes of modern bariatric procedures are invaluable for clinicians and families considering ways to support adolescents facing obesity, especially in cases of rapid weight gain,” added Dr Inge, who also directs the hospital’s bariatric surgery programme.

The trial, which ran from 2006 to 2012, included approximately 260 adolescents aged 13 to 19, who underwent bariatric surgery at one of five centres in the United States, including Cincinnati Children’s, Texas Children’s Hospital in Houston, Children’s Hospital of Alabama in Birmingham, the University of Pittsburgh Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio.

Adolescents with severe obesity who had bariatric surgery before age 19 experienced sustained weight loss a decade later. Additionally, they showed significant resolution of obesity-related health conditions, including type 2 diabetes, hypertension, and elevated cholesterol. Researchers reported that participants maintained substantial reductions across these conditions, with an average 20% decrease in body mass index (BMI), a 55% reduction in type 2 diabetes, a 57% decrease in hypertension, and a 54% improvement in abnormal cholesterol.

The benefits of surgery appeared similar between those who underwent gastric bypass and those who received sleeve gastrectomy, indicating both procedures are effective in treating obesity-related health issues in young people.

Importantly, the study found that the 55% reduction in type 2 diabetes in adolescents following surgery was far greater than that observed in adults who had undergone the same procedures. Recent NIH-funded studies in adults showed only an 18% decrease in diabetes after seven years and 12.7% after 12 years. Given the rapid progression of type 2 diabetes in young people, this study demonstrates the considerable long-term health benefits of bariatric surgery when undertaken during adolescence.

“This study underscores that surgical treatment should be considered earlier in the course of severe obesity,” Dr Inge remarked. However, he highlighted a critical barrier to access: fewer than 1% of eligible adolescents with severe obesity receive surgery due to parental reservations and other factors. “We should advocate for early intervention and ensure that adolescents have access to effective therapies to mitigate the progression of obesity-related conditions, such as type 2 diabetes and hypertension,” Dr Inge emphasised. In addition to his role at Lurie Children’s Hospital, Dr Inge serves as a professor of surgery and paediatrics at Northwestern University Feinberg School of Medicine in Chicago.

The study has received praise from other experts in adolescent weight management, who recognise the growing importance of effective interventions for severe obesity in young people. “The rate of obesity continues to rise in children, threatening to impact future life expectancy and healthcare costs,” noted Dr Kirk Reichard, surgical director of the bariatric surgery programme at Nemours Children’s Hospital in Wilmington, Delaware. Although not directly involved in the study, Dr Reichard underscored the critical need to address paediatric obesity. “While efforts to address prevention are critical, the reality is that 20% of American children are now affected by obesity and need our help,” said Dr Reichard, who is also a clinical professor of surgery and paediatrics at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia.

Another expert, Dr Andrea Coviello, an endocrinologist and director of the weight management programme at the University of North Carolina School of Medicine in Chapel Hill, pointed out that long-term data on bariatric surgery in younger patients has been limited. “There has been a lack of long-term data on the benefits and risks of bariatric surgery in younger patients,” Dr Coviello said, adding that “this study helps to fill in knowledge gaps that may help healthcare providers and parents to make informed decisions about healthcare options for children with obesity and obesity-related conditions such as type 2 diabetes.”

Dr Coviello encouraged parents to seek guidance from paediatricians and weight-loss specialists if their children are affected by obesity, particularly if they experience related health issues such as type 2 diabetes or high blood pressure. “Appropriate care and weight loss earlier may significantly improve their child’s health in the longer term,” she noted.

The findings of this study hold significant implications for addressing severe obesity in adolescents, demonstrating that early surgical intervention can lead to sustained health improvements and potentially prevent the worsening of obesity-related conditions later in life.