ESPE Yearbook of Paediatric Endocrinology

N Engl J Med. 2024 Oct 31;391(17):1656-1658. doi: 10.1056/NEJMc2404054. https://pubmed.ncbi.nlm.nih.gov/36443241/

Brief Summary: The prospective, multicenter observational cohort study “Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS)” included 260 adolescents (aged 13-19 years) undergoing bariatric surgery. Both Roux-en-Y gastric bypass and sleeve gastrectomy resulted in sustained weight loss (−20%; 95% CI: −22.9 to −17.1) and long-term remission of key obesity-related comorbidities over a 10-year period.

The Teen-LABS cohort [1] provides critical long-term evidence supporting the efficacy and durability of bariatric surgery in adolescents with severe obesity. In this prospective, multicenter cohort, of 260 participants, adolescents undergoing either Roux-en-Y gastric bypass or sleeve gastrectomy achieved substantial and sustained reductions in BMI (mean −20%; 95% CI: -22.9 to -17.1), with similar trajectories observed across both procedures. Latent class analysis identified distinct patterns of weight change, with greater early postoperative weight loss emerging as a strong predictor of long-term success. Beyond weight reduction, the study demonstrates durable remission of major obesity-related comorbidities. At 10 years, remission rates were 55% for type 2 diabetes, 57% for hypertension and 54% for dyslipidemia. Notably, the remission rate for type 2 diabetes exceeded those reported in adult cohorts [2], underscoring the potential metabolic advantages of earlier surgical intervention.

These findings support the concept that bariatric surgery may meaningfully alter the progression of obesity-related disease. The study’s strengths include its prospective design, standardized methodology, and excellent follow-up (>90%) across multiple centers. However, limitations, such as the absence of a non-surgical control group and limited statistical power for certain comorbidity outcomes, should be considered when interpreting the results.

Teen-LABS provides compelling evidence for the integration of bariatric surgery into structured, guideline-based obesity care in adolescents.

References: 1. Inge T H, Zeller M H, Jenkins T M, Helmrath M, Brandt M L, Michalsky M P, Harmon C M, Courcoulas A, Horlick M, Xanthakos S A, Dolan L, Mitsnefes M, Barnett S J, Buncher R; Teen-LABS Consortium. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 2014, 168 (1), 47-53, doi:10.1001/jamapediatrics.2013.4296.2. Courcoulas A P, Patti M E, Hu B, Arterburn D E, Simonson D C, Gourash W F, Jakicic J M, Vernon A H, Beck G J, Schauer P R, Kashyap S R, Aminian A, Cummings D E, Kirwan J P. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA 2024, 331(8), 654-664, doi: 10.1001/jama.2024.0318.