Study reveals long-term results of weight loss surgery in children and adolescents with severe obesity

The results of a 10-year study of children and adolescents who underwent routine weight loss surgery to treat severe obesity show that they safely have major and lasting weight loss and improvement in their obesity-related medical problems without stunting their growth in height. The study, involving the longest known follow-up of pediatric patients after laparoscopic sleeve gastrectomy, is published online by the Journal of the American College of Surgeons before printing.

According to the study authors from Saudi Arabia, where the research took place, there was not enough information on the results of this weight loss surgery in children and adolescents over five years old. Also called a gastric sleeve procedure, sleeve gastrectomy is now more popular than gastric bypass due to lower complication rates.

During this operation, surgeons divide and remove part of the stomach, leaving the remaining stapled parts to create a “sleeve” in the shape of a stomach the size of a banana. This new, smaller tubular stomach allows patients to eat less and lose weight. It’s also effective because surgeons remove the part of the stomach that contains the “hunger” hormone that stimulates appetite.

The lack of long-term data and the fears of some pediatricians that bariatric surgery may affect the linear growth of children has led to worldwide resistance to performing weight loss procedures in children under the age of 14 or 15. “

Aayed R. Alqahtani MD, FACS, FRCSC, lead study author and professor, bariatric and minimally invasive surgery, King Saud University

Aayed R. Alqahtani is also Managing Director of New You Medical Center in Riyadh, Saudi Arabia.

The results of their long-term study showed that patients lost almost 30% of their total weight, on average, and had a generalized reversal of type 2 diabetes and the major risk factors for heart disease, with no death or Major complications related to the procedure, reported Dr Alqahtani. .

“Our results present clear evidence that should eliminate the reluctance to perform bariatric surgical treatment in children and young adolescents who might benefit from the operation,” he said. “We have a proven solution for severe obesity and its co-morbidities [related diseases]. “

The largest study on pediatric sleeve gastrectomy

This study is the largest of its kind to date in this age group, with more than 2,500 participants aged 5 to 21, reported Dr Alqahtani. Almost a third were under 15 at the time of their surgery, which he says is younger than in many American studies.

All of the patients had severe obesity, which is at least 120 percent of the 95th percentile for age and sex on the Centers for Disease Control and Prevention growth charts. The patients were reportedly unable to lose substantial weight despite a six-month weight loss program involving dietary and behavioral counseling.

Between 2008 and 2021, patients underwent a sleeve gastrectomy. Before the operation, about one in 10 people had type 2 diabetes or abnormal lipids (blood fats). High blood pressure was even more prevalent in 15 percent of these young patients. Obesity, which affects 18.5% of young Americans, increases the risk of these serious medical problems as well as fatty liver disease, sleep apnea, and depression, among others.

Sustainable weight loss and improved health

Pediatric patients continued to have good results seven to ten years after the operation:

  • They maintained an average loss of 71 percent of excess weight.
  • Type 2 diabetes has resolved in more than seven out of ten patients.
  • Lipids and blood pressure became normal in over 57% of each of the patients who previously had abnormal lipids and high blood pressure, two risk factors for heart disease.

Because many of their patients had not yet reached full adult height, the researchers were able to compare the rate of growth, the rate of growth in height, between younger and older pediatric patients. They found that growth rate was not affected and did not differ between patients 14 years of age or younger and those over 14 years of age.

Results in line with current guidelines

Their results match current scientific evidence recommending early surgery, said Dr Alqahtani. The most recent guidelines from the American Academy of Pediatrics and the American Society for Metabolic and Bariatric Surgery do not advise to wait until a child reaches maturity if the operation is recommended for the child based on his or her. weight and obesity-related diseases.

“If you do surgery early, you can cure obesity-related illnesses in children and improve their quality of life, and if you wait longer, their illnesses may become irreversible,” Dr Alqahtani said.

Dr Al-Qahtani attributed their good results to the following factors:

  • The surgeon used differences in the gastric sleeve they created, which he said made him less likely to gain weight.
  • Patients had permanent access to follow-up care and telephone contact with the surgical and medical team.
  • The patient’s family helped ensure their child’s compliance with post-operative recommendations.

Another strength of the study, Dr Alqahtani said, is that their patient population had a more even gender distribution than previous studies. Girls are more likely than boys to have weight loss surgery. but male patients made up 45 percent of their sample.

Source:

Journal reference:

Alqahtani, AR, et al. (2021) Ten-year outcomes of children and adolescents with sleeve gastrectomy: weight loss, resolution of co-morbidities, adverse events, and growth rate. Journal of the American College of Surgeons. doi.org/10.1016/j.jamcollsurg.2021.08.678.


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