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Morbid obesity in pediatric diabetes mellitus: surgical options and outcomes

Nature Reviews Endocrinology volume 6, pages 637–645 (2010)Cite this article

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Abstract

The current obesity epidemic has led to a dramatic increase in insulin resistance and type 2 diabetes mellitus among adolescents, along with other obesity-related comorbidities, such as hypertension, hyperlipidemia, obstructive sleep apnea, psychosocial impairment and nonalcoholic fatty liver disease. Medical treatment of severe obesity is effective in only a small percentage of adolescent patients. In light of the potentially life-threatening complications of obesity, bariatric surgery can be considered a treatment option for adolescent patients with morbid obesity. Indications for surgery rely on both BMI and comorbidity criteria, as well as the ability of the adolescents and their family to understand and comply with perioperative protocols. The long-term effects of bariatric surgery in adolescents are not known; therefore, participation in prospective outcome studies is important. The risk associated with bariatric surgery in adolescents seems to be similar to that observed in adult patients in the short term. Data suggest that bypass procedures successfully reverse or improve abnormal glucose metabolism in the majority of patients and may be more effective in adolescents than adults. This improvement in glucose metabolism occurs before marked weight loss in patients undergoing bypass procedures, suggesting a direct effect on the hormonal control of glucose metabolism.

Key Points

  • Bariatric surgery has been shown to improve glucose metabolism in adolescents and adults with morbid obesity

  • Improvement in glucose metabolism after gastric bypass seems to be independent of weight loss, which suggests a direct hormonal effect

  • Bariatric surgery in adolescents seems to have the same short-term risks and benefits as seen in adults

  • The singular needs of adolescents make stringent indications for bariatric surgery mandatory

  • Early intervention in patients with insulin resistance could theoretically result in more effective reversal of this condition and prevention of diabetes mellitus

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Figure 1: Current bariatric procedures for surgically induced weight loss.75

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Authors and Affiliations

  1. Department of Surgery Texas Children's Hospital, 6621 Fannin Street, Houston, 77030, TX, USA

    Mary L. Brandt

  2. Department of Pediatrics, Texas Children's Hospital, 6621 Fannin Street, Houston, 77030, TX, USA

    Siripoom V. McKay

  3. Department of Surgery, University of Alabama, 1600 7th Avenue South, Birmingham, 35233, AL, USA

    Carroll M. Harmon

  4. Department of Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, 45229, OH, USA

    Michael A. Helmrath & Thomas H. Inge

  5. Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Childrens Drive, Columbus, 43205, OH, USA

    Marc P. Michalsky

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The authors contributed equally to researching the data for the article, discussions of the content, writing of the article and reviewing and/or editing of the manuscript before submission. The names are in alphabetical order to represent this equal contribution.

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Correspondence to Mary L. Brandt.

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Brandt, M., Harmon, C., Helmrath, M. et al. Morbid obesity in pediatric diabetes mellitus: surgical options and outcomes. Nat Rev Endocrinol 6, 637–645 (2010). https://doi.org/10.1038/nrendo.2010.167

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