ESPE Yearbook of Paediatric Endocrinology

Brief summary: The AMOS2 study is a randomized, open label, multicentre trial. It reports 2-year BMI changes in n=25 adolescents (age 13–16 years) after metabolic and bariatric surgery (MBS) (Roux-en-Y gastric bypass n=23, sleeve gastrectomy n=2) compared to n=23 adolescents who received intensive non-surgical treatment. After 2 years, BMI change was −12.6 kg/m² in the MBS group compared to only −0.2 kg/m² in the non-surgical treatment group.

In 2015, a Cochrane review highlighted the lack of randomized trials comparing MBS to other treatment modalities in adolescents with obesity (1). That review identified only one randomized controlled trial of adjustable gastric banding. That RCT among adolescent with obesity reported that gastric banding, compared with lifestyle intervention, resulted in a greater percentage achieving 50% reduction in excess weight, corrected for age (2). However, gastric banding is in limited use in adolescents due to associated high long-term re-operation rates.

The AMOS2 study is the only study that compared currently preferred MBS techniques with intensive non-surgical treatment. MBS was superior to intensive non-surgical treatment over 2 years in achieving weight loss among adolescents with severe obesity. This RCT and other observational studies (3–5) have shown that MBS is associated with substantial weight loss, improvement of cardiometabolic risk factors and quality of life in the short and medium term. But there is still the question of the long-term effects of an MBS.

In another recent paper, Beamish et al. reviewed published data on the results of MBS in adolescents with a focus on long-term outcomes. They highlighted that further studies are warranted to investigate long-term safety and efficacy and the role of adjunctive pharmacological treatment (6).

References: 1. Ells LJ, Mead E, Atkinson G, Corpeleijn E, Roberts K, Viner R, Baur L, Metzendorf MI, Richter B. Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2015, Cd011740, doi: 10.1002/14651858.Cd011740. 2. O’Brien PE, Sawyer SM, Laurie C, Brown WA, Skinner S, Veit F, Paul E, Burton PR, McGrice M, Anderson M, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. Jama 2010, 303, 519–526, doi:10.1001/jama.2010.81. 3. Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, Harmon CM, Zeller MH, Chen MK, Xanthakos SA, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med 2016, 374, 113–123, doi:10.1056/NEJMoa1506699. 4. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, Ekbom K, Friberg P, Göthberg G, Järvholm K, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol 2017, 5, 174–183. doi:10.1016/s2213-8587 (16)30424-7. 5. Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, Helmrath MA. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol 2017, 5, 165–173. doi:10.1016/s2213-8587 (16)30315-1. 6. Beamish AJ, Harper ER, Järvholm K, Janson A, Olbers T. Long-term outcomes following adolescent metabolic and bariatric surgery. J Clin Endocrinol Metab 2023. doi:10.1210/clinem/dgad155.