Though adolescents with severe obesity had improved clinical outcomes with metabolic and bariatric surgery (MBS), only a small percentage of adolescents referred for MBS proceeded to surgery, despite its benefits, according to study results published in Journal of Pediatric Gastroenterology and Nutrition.
Given that MBS can be an efficacious and well tolerated treatment option for adolescents with severe obesity, researchers of the current study sought to compare outcomes between adolescents that did and did not proceed to MBS after referral. They also determined factors influencing surgery denial among adolescent patients.
Researchers conducted a longitudinal study from a single-site bariatric center from 2015 to 2020. The study included 2 groups: patients who completed laparoscopic sleeve gastrectomy (LSG) within 6 months of initial referral and patients who opted out of surgery (NoLSG). The outcomes were compared over 24 months.
Adolescents with a median age of 16 years were included in the study, of which 69% were girls, 38% were Hispanic, and 78% had noncommercial insurance. The median baseline weight and body mass index (BMI) were 134 kg and 48.4 kg/m2, respectively; 42% of all referrals had a BMI greater than 50 kg/m2.
Of the 352 adolescents referred for MBS, only 79 (22%) underwent LSG, whereas 273 (78%) did not proceed within 6 months of referral.
Reported reasons identified for patients in the NoLSG group included failure to return for the second surgical visit (62%), nonadherence to clinical recommendations (10%), insurance denials (6%), psychological contraindications (including recent suicidal ideations) (6%), and patients who are still in the preoperative 6-months phase.
Results of the study reported that patients who underwent LSG had a significant reduction in their weight and BMI from referral to surgery (135 vs 127 kg and 48.4 vs 45 kg/m2, respectively; P <.01), whereas patients from the NoLSG group continued to gain weight over 24 months. The total weight loss and BMI loss for patients from the LSG group were 21% and 22%, respectively. Conversely, the total weight gain and BMI gain for patients from the NoLSG group were 4% and 3%, respectively.
Overall, a significant resolution of obesity-associated conditions such as hypertension, diabetes, and obstructive sleep apnea was observed among patients from the LSG group. In contrast, none of the patients from the NoLSG group had any resolution.
Patients from both groups had poor follow-up; ≤30% were evaluated at 24 months. The study also reported that patients opting for LSG were more likely to have public health insurance and have BMIs between 50 to 59.9 kg/m2.
Study limitations include its single-center design, poor follow-up rates, and lack of consistent behavioral assessment and monitoring of patients.
Researchers concluded, “A minority (22%) of adolescents referred for MBS proceeded to surgery, despite its demonstrated efficacy and safety in adolescence. Those that did not undergo surgery continued to gain weight.”
Qureshi FG, Wiegand JG, O’Neill G, et al. Longitudinal outcomes in adolescents after referral for metabolic and bariatric surgery. J Pediatr Gastroenterol Nutr. 2021;73(6):677-683. doi:10.1097/MPG.0000000000003290