Childhood obesity is a serious public health challenge. Bariatric surgery is gaining popularity as a treatment modality for severely obese adolescents.
Backgrounds: To report the safety and 1 year outcome data on morbidly obese adolescents that underwent bariatric surgery at a tertiary hospital in the UK.
Methods: A retrospective review of patients (mean preoperative BMI 50.4 kg/m2; mean BMI SDS +4.2) who underwent bariatric surgery from 2011 to 2017 was performed. Comorbidities included hypertension, insulin resistance, obstructive sleep apnoea, limited mobility and psychosocial issues. Weight loss as measured by percent excess weight loss (%EWL) at 1 year post-operatively, resolution of known comorbidities and occurrence of complications were evaluated. Serum ferritin, folate, vitamin B12 and haemoglobin levels were reviewed for identification of nutritional deficiencies.
Results: Bariatric surgery (three gastric bands and fifteen sleeve gastrectomies) was performed in eighteen patients (M=5, F=13). Mean percentage weight loss, as a percentage of total body weight at 6 (n=17) and 12 (n=13) months, was 21.0 and 24.5%, respectively. Mean BMI at 12 months post-procedure was 36.5 kg/m2 - a mean fall of 14.3 kg/m2 (median 14.5). Mean BMI SDS fell from +4.2 to +3.5 at 6 month and +3.0 at 12 months.
There were no post-operative surgical complications. Resolution of diabetes occurred in the single patient diagnosed with T2DM (HbA1c dropped from 8.9 to 5.2% at the end of 1 year). All five patients diagnosed with hypertension had resolution of hypertension post-operatively. Mean HOMA improved from 7.4 pre-surgery to 2.4 at the end of 1 year (n=6). Mean vitamin D levels pre-operatively were low at 29.2 nmol/l and improved at 6 months to 50.8 nmol/l (n=6) with supplementation. Two patients developed anaemia 1 year post-operatively associated with significant weight loss.
Conclusions: Bariatric surgery is effective and safe treatment modality of severely obese adolescents in the short term. Further studies are required to investigate the long-term effects of bariatric surgery in adolescents. Follow-up into adulthood is recommended.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes