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  • Bariatric and Metabolic Surgery Original Article
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Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

International Journal of Obesity volume 36, pages 1388–1395 (2012)Cite this article

Abstract

CONTEXT:

The prevalence of obesity among adolescents has increased and we lack effective treatments.

OBJECTIVE:

To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care.

DESIGN, SETTING AND PATIENTS:

Intervention study for 81 adolescents (13–18 years) with a body mass index (BMI) range 36–69 kg m−2 undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care.

MAIN OUTCOME MEASUREMENTS:

Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group.

RESULTS:

Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5±6.1 (mean ±s.d.) at baseline and 30.2 (confidence interval 29.1–31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l−1) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients.

CONCLUSIONS:

Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.

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Acknowledgements

We thank M Engström for invaluable help in setting up the study database and all the excellent staff at the pediatric obesity centers in Stockholm (C Nairn, E Forsell and G Lindmark), Gothenburg (A Laurenius, M Persson and J Curland) and Malmö (K Järvholm, H Helgesson, B Bengtsson and J Derwig). The primary funding source was from Västra Götalandsregionen http://www.vgregion.se/sv/Vastra-Gotalandsregionen/startsida/ and Stockholm County Councils, Swedish Board of Health and Wellfare. Funding organizations were not involved in the design and conduct of the study or in the collection, management, analysis, and interpretation of the data. Similarly, funding organizations were not involved in the preparation, review or approval of the manuscript. Medical writers have not been used.

Author Contributions

TO, MP, EG and CM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TO, SM, CEF and CM. Acquisition of data: TO, EG, MW, SM, CEF, GG, KE, JD, HL and CM. Analysis and interpretation of data: TO, EG, MW, SM, CEF, KE, MP, JK, LVS, JD, PF and CM. Drafting of the manuscript: TO, EG and CM. Critical revision of the manuscript for important intellectual content: TO, EG, SM, CEF, MP, GG, JK, LVS, JD, PF and CM. Statistical analysis: MP and EG. Obtained funding: TO and CM. Study supervision: TO, SM, CEF and CM.

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Authors and Affiliations

  1. Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Medicine, Clinical Physiology and Paediatrics (Queen Silvia Children’s Hospital), Gothenburg, Sweden

    T Olbers, E Gronowitz, M Werling, S Mårlid, G Göthberg, J Karlsson, L V Sjöström, J Dahlgren, H Lönroth & P Friberg

  2. Department of Surgery, Imperial College, London, UK

    T Olbers

  3. Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden

    C-E Flodmark

  4. National Institute for Health and Welfare, Helsinki, Finland

    M Peltonen

  5. Center for Health Care Sciences, Örebro University Hospital, Örebro, Sweden

    J Karlsson

  6. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    K Ekbom & C Marcus

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  1. T Olbers
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Correspondence to T Olbers.

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Supplementary Information accompanies the paper on International Journal of Obesity website

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Olbers, T., Gronowitz, E., Werling, M. et al. Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS). Int J Obes 36, 1388–1395 (2012). https://doi.org/10.1038/ijo.2012.160

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