MTD approach to weight management a viable option for adolescents with obesity
Updated: Jun 8, 2022
Increased access to an adolescent-centred healthy weight management program, including bariatric surgery, is paramount to achieving the best long-term outcomes as adolescents with obesity grow to adulthood, according to a study led by researchers from Hassenfeld Children’s Hospital at NYU Langone and Children’s National Hospital in Washington, DC.
The study, ‘The impact of parental bariatric surgery and patient age on laparoscopic sleeve gastrectomy outcomes in adolescents’, published in Surgical Endoscopy, found that adolescents with obesity who underwent laparoscopic sleeve gastrectomy (LSG), benefited from less obesity and concomitant organ damage no matter their age at the time of surgery. This applied to children as young as 13 years of age. The study also revealed that adolescents with a parent who underwent bariatric surgery themselves, had a higher weight prior to weight loss surgery, suggesting the familial nature of chronic obesity.
“If obesity has negative effects on overall health, then why not take care of it early?” said study lead author, Dr Jun Tashiro, a paediatric surgeon specializing in bariatric surgery at the Adolescent Healthy Weight Program, part of Hassenfeld Children’s Hospital at NYU Langone, and an assistant professor in the Division of Pediatric Surgery, in the Department of Surgery at NYU Langone Health. “Addressing the ‘toxic exposure’ with early interventions in any instance as long as it is safe will lower the negative consequences, such as high blood pressure, high cholesterol, diabetes, musculoskeletal problems, breathing problems, anxiety and depression.”
For teens ages 13+ who have a body mass index (BMI) of 35 or higher and have been unsuccessful through traditional weight-loss measures or who suffer from obesity-related health conditions, bariatric surgery is a safe, effective treatment toward developing a healthier and more active life.
There have been an increasing number of studies specifically designed to address the safety and effectiveness of bariatric surgery in this younger population, coupled with recent reports highlighting the many health-related medical problems teens with severe obesity face, a national consensus in support of this treatment regimen for younger populations has emerged. However, most facilities nationwide are limited in their ability to treat adolescents younger than 16 years of age. For this reason, younger patients may not have the same access to bariatric surgery as older individuals.
This study evaluated the effects of parental history of bariatric surgery, as well as age at the time of operation, on 328 adolescents who underwent LSG at Children’s National Hospital in Washington, DC, between January 2010 and December 2019. Among the 31 percent of adolescents younger than 16 years, no differences in weight loss trends were demonstrated in comparison to the 69 percent 16 years or older. The study also demonstrated that the 76 patients with parental history of surgery had a higher absolute weight at the time of presentation, suggesting the adherence to the familial, polygenic nature of obesity.
“Although there were no differences in weight loss outcomes for those patients whose parents have or have not had bariatric surgery themselves, given their heavier size at age of surgery, there may be benefit in ensuring even earlier access to care for these children and adolescents,” explained Tashiro.
Multidisciplinary adolescent weight loss programs focus on the entire child and family, addressing the psychological, social, nutritional, hormonal, genetic, activity, neurological and sleep issues that may contribute to excess weight gain. The study authors emphasise that freestanding children’s hospitals or those within a larger adult facility are in a unique position to offer bariatric surgery to younger patients, particularly those younger than 16 years of age.
“This study shows that bariatric surgery is just as effective for younger adolescents as for older kids,” says study senior author, Dr Evan Nadler, director of the Child and Adolescent Weight Loss Surgery Program at Children’s National Hospital. “Adolescents and teens with severe obesity face many significant barriers to accessing metabolic bariatric surgery, and while they wait, obesity-related comorbidities may continue to develop and impact their health. We as doctors should work together to remove these barriers when appropriate, so more young people who need this safe and effective treatment can get it.”
Further research about how long-term comorbidities develop in adolescents with obesity is warranted for further understanding of the benefits of early bariatric surgery intervention.