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The current paradigm of bariatric surgery in adolescents

Nature Reviews Gastroenterology & Hepatology volume 20, pages 1–2 (2023)Cite this article

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Severe obesity in adolescents affects their health and quality of life. Currently, metabolic and bariatric surgery (MBS) is the only effective intervention, but only a limited number of individuals undergo MBS procedures. Therefore, vigorous research in MBS is a priority for the benefit of adolescents with obesity.

Severe obesity (body mass index (BMI) >1.2 × 95th percentile or 35 kg/m2) affects 8% of adolescents in the USA, negatively influencing their physical health, psychological well-being and quality of life. In addition, severe obesity in youth has been associated with a 7–14-year reduction in life expectancy1. Despite considerable efforts to improve treatment options for these youth, the only intervention with evidence of long-term efficacy (>1 year) is metabolic and bariatric surgery (MBS)2. MBS in adolescents results in superior weight loss (~25%) than conventional weight management (~2%). In adults, MBS provides not only durable weight loss but also a substantial survival advantage, a finding that has not yet been duplicated in those who have undergone MBS as a youth due to the lack of longer-term follow-up. Despite the well-documented and marked clinical benefits of MBS for adolescents, and the fact that 1.6 million adolescents in the USA qualify for MBS based on updated clinical criteria3, paradoxically, only 4 out of 10,000 undergo MBS procedures in the USA. The reasons for this low utilization are likely numerous, but sparse evidence of long-term efficacy and safety are likely to be the main drivers of this underused but effective therapy for severe adolescent obesity.

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Acknowledgements

The authors thank R. Boles for his careful review of this manuscript and thoughtful input into its content.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Thomas H. Inge

  2. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Thomas H. Inge

  3. Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

    Justin R. Ryder

  4. Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Justin R. Ryder

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  1. Thomas H. Inge
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Correspondence to Thomas H. Inge.

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Inge, T.H., Ryder, J.R. The current paradigm of bariatric surgery in adolescents. Nat Rev Gastroenterol Hepatol 20, 1–2 (2023). https://doi.org/10.1038/s41575-022-00713-8

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