Bariatric Surgery in Adolescents: An Update

Bariatric surgery is a promising, although still controversial, weight loss tool for selected extremely obese adolescents who have failed conventional medical and behavioral therapy for obesity. Early reports of bariatric surgery in adolescents have shown success with this procedure, despite a much higher mean BMI than adult candidates, but long-term studies are necessary to allow quantitative meta-analysis. Rates of morbidity and mortality after bariatric surgery and resolution of preoperative comorbidities need to be rigorously and prospectively studied. Although it would be important to ensure adequate surgeon and hospital procedural volume for all programs accepting adolescent candidates, it is unlikely that any program specifically geared to meet the complex needs of adolescents would attain the volumes reached by larger adult centers. Optimal criteria for adolescent bariatric centers of excellence need to be defined. Comparison of different surgical techniques, including adjustable gastric banding and gastric bypass, is required. Prospective studies of nutrient deficiencies are crucial to determine the long-term prevalence and clinical significance of these deficiencies in adolescent bariatric recipients and to identify optimal dietary supplementation. In addition, data on psychosocial development and quality of life need to be longitudinally collected, and predictors of long-term success need to be defined. Surgery alone is not likely to be a panacea for all; efficacy of bariatric surgery is linked to continuing follow-up and adherence to a specialized dietary regimen [113]. Surgical bypass may lead to alterations in neuroenteric hormonal axes that regulate appetite and physical activity and that may play a role in the long-term success of bariatric surgery and long-term weight maintenance [114,115]. Changes in gastrointestinal hormones, such as ghrelin, glucagon-like peptide-1, and peptide YY, continue to be investigated before and after bariatric surgery [116-118]. Although the specific recommendations for bariatric surgery in adolescents undoubtedly will evolve as more data are collected from multicenter studies, adolescent bariatric surgery should continue to occur within a pediatric-oriented multidisciplinary team, to provide optimal counseling, evaluation, and support geared to adolescents and their families.