ESPE Yearbook of Paediatric Endocrinology

Pediatrics 2021 Mar;147(3):e2020024182. 10.1542/peds.2020-024182 https://pubmed.ncbi.nlm.nih.gov/33526606/

This sub-analysis of Teen-LABS study shows very similar improvements over 5 years after bariatric surgery between younger and older adolescents with severe obesity in %BMI change (−22.2% vs. −24.6%, respectively), resolution of hypertension and dyslipidaemia, and quality of life. Importantly, there was a trend towards lower likelihood of nutritional deficiencies in younger adolescents, possibly due to greater control within the home environment. A small difference in remission of T2DM in younger and older adolescents was also observed, but the overall rate of T2DM remission is comparable to published data.

Teen-LABS is a multicentre prospective observational US study, which enrolled 242 adolescents who underwent bariatric surgery (MBS) between 2007 and 2012. Here, they stratified the cohort into 2 age groups: 13–15 years and 16–19 years at the time of surgery. Participants were regularly assessed up to 5 years after MBS. The main outcomes were changes in hypertension, dyslipidaemia, type 2 diabetes, micronutrient status and quality of life.

The prevalence of severe childhood and adolescent obesity and its comorbidities has led to a crisis in treatment response. Although behavioural interventions can be successful for some individuals, the overall results are discouraging when considered as a solution to the large number of obese patients (1-5). In contrast, the effectiveness of bariatric surgery in terms of weight reduction and improved quality of life in adolescents has been clearly demonstrated in clinical trials. Comparative outcome data of bariatric procedures between younger and older adolescent patients could provide important information for choosing the best possible timing of surgery (6).

Strengths of the present work include a large and well-characterised cohort and extensive follow-up. Limitations arise from the non-randomised design, and especially the limited generalisability due to the high proportion of white, female patients. Although long-term data of at least comparable quality over follow-up periods of more than five years are still urgently needed, these Teen-LABS data suggest that in younger adolescents with severe obesity, surgical therapy - as an ultima ratio (last resort) option - should not be rejected solely on the basis of the patient’s age.

References: 1. Denzer C, E Reithofer, M Wabitsch, K Widhalm 2004 The outcome of childhood obesity management depends highly upon patient compliance. Eur J Pediatr 163:99–104.2. Kalarchian MA, Levine MD, Arslanian SA, et al. Family-based treatment of severepediatric obesity: randomized, controlled trial. Pediatrics. 2009;124(4): 1060–1068.3. Hoffmeister U, M Bullinger, A van Egmond-Frohlich, C Goldapp, R Mann, U Ravens-Sieberer, T Reinehr, J Westenhofer, N Wille, RW Holl 2011 [Overweight and obesity in childhood and adolescence. Evaluation of inpatient and outpatient care in Germany: the EvAKuJ study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 54:128–135.4. Danielsson P, Kowalski J, Ekblom O?, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med. 2012;166(12):1103–1108.5. Knop C, Singer V, Uysal Y, et al. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes. 2015;10(1):7–14.6. Armstrong SC, Bolling CF, Michalsky MP, Reichard KW. Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices. Pediatrics. 2019;144(6):e20193223.