Bariatric Surgery in Adolescents

The prevalence of severe obesity among children and adolescents continues to increase and poses a serious healthcare challenge both in the United States and worldwide. Recently, it has been reported that approximately 8% of adolescents (12-19 years of age) are severely obese (BMI ≥120% of the 95th percentile in younger adolescents or BMI ≥35 kg/m2 in older adolescents). The medical community is facing a concurrent increase in the number and severity of obesity-related comorbid illnesses (i.e., hypertension, insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea, dyslipidemia, nonalcoholic fatty liver disease, etc.). In response to disappointing outcomes related to nonsurgical weight loss strategies, as well as a growing body of literature demonstrating the safety and efficacy of metabolic and bariatric surgery (MBS), there has been increased enthusiasm for the use and standardization of MBS in adolescents. This effort is aimed to not only obtain durable weight loss but abrogate the potential long-term comorbid conditions associated with chronic obesity. In this chapter, we will review recent data regarding the development and progression of several commonly encountered obesity-related comorbid illnesses in the pediatric population, which serve as an important foundation supporting the application of adolescent MBS. In addition, we will review current pharmacotherapeutic agents used for adolescent obesity and evidence-based recommendations regarding the use of specific bariatric procedures. We will focus on longitudinal outcomes and associated complications and provide a brief review of the current recommendations for the multidisciplinary care of the adolescent bariatric patient.