The Long Lasting Effects of Bariatric Surgery in Adolescents

Texas Children’s Hospital Bariatric Surgery Program has recently received preliminary approval for accreditation by the Metabolic and Bariatric Accreditation and Quality Improvement Program. Their program over the past 7 years has met stringent guidelines in areas of surgical excellence and education as well as patient outcomes and ongoing quality improvement.  

“We did our 100th case in January 2022, and since then we’ve done another 150, so it’s really growing,” said Shawn Stafford, MD, surgical director of Texas Children’s Bariatric Surgery Program.  

Despite the American Academy of Pediatrics’ (AAP) recent endorsement of bariatric surgery for treatment of pediatric obesity, many remain skeptical, and the surgery can be difficult to access for many patients. There are only 6 accredited programs affiliated with children’s hospitals, besides Texas Children’s. 

“I think that bariatric surgery should really be a priority for children’s hospitals all over the country,” said Dr. Stafford.  

The need for bariatric surgery 

The scope of the pediatric obesity pandemic is vast. One study in 2016 estimated that by 2025, 91 million children worldwide will be obese. The Centers for Disease Control estimates that in 2020, 14.7 million American children were obese. Children are at risk for the sequelae of obesity, such as type 2 diabetes, hypertension, stroke and renal failure, similar to adults but for children, there are additional risks.  

“The disease processes are progressing much faster in children. They estimate that it takes 10 – 20 years off the life expectancy of these kids, which is significant. In addition, it increases the risk of cancer by up to 400% because obese is a proinflammatory state, and inflammation is associated with high cell turnover, which is associated with malignancy,,” said Dr. Stafford. 

Placing a gastric sleeve in an adolescent, the only operation performed unless there are contraindications such as severe reflux, is a relatively safe procedure, with micronutrient deficiency being the main long term complication. Regular vitamin supplementation will prevent any deficiencies. Patients, families, primary providers and emergency room professionals should all be aware, however, that in an ill patient, administration of intravenous fluids with glucose prior to replacing any thymine or other B vitamins deficiency can trigger an irreversible Wernicke’s encephalopathy.    

Long term results 

While lifestyle modification is essential to the success of any bariatric surgery, by itself “no studies to date demonstrate significant and durable weight loss among youth with severe obesity,” according to the AAP.  

The youngest age for bariatric surgery at Texas Children’s is 14 years old. A multidisciplinary team, including physicians, surgeons, dieticians, social workers and psychologists, works together to decide if a patient is mature enough to manage their own diet and make the lifestyle changes that provide lasting weight loss success.  

“Following surgery, we see a year of good weight loss. Then they’re going to stabilize, and maintaining that weight loss relies on lifestyle changes. That’s why we take 6 months preoperatively to work with patients exclusively on lifestyle. We expect there will be some weight gain moving forward, but not usually to the point where they were before,” said Dr. Stafford.  

These lasting results are part of the reason bariatric surgery can be so effective in adolescents. For adults who have been obese much of their lives, it is harder to reverse the sequelae, such as diabetes and hypertension.  

“For an adult with type 2 diabetes who has bariatric surgery, about 80% will be off diabetes medications the day after surgery, which is pretty impressive, but that number drops after 5 years to about 45%. With kids, we see that 100% of kids are off their medications the day after surgery and at 5 years, 85 – 87% will still have no sign of diabetes,” said Dr. Stafford.  

The true longevity of bariatric surgery, however, comes when considering generational change. When adolescents who are dedicated to positive lifestyle changes following bariatric surgery grow up and start families of their own, they are able to teach their children how to be healthy by example.  

“My hope is that these surgeries will have a domino effect and make a lot more progress towards stopping obesity, not just for the people who get the surgery but the people who benefit from associating with them,” said Dr. Stafford.  

Make a referral to the Texas Children’s Bariatric Surgery Program through their online portal or by calling 936-267-7333.