Bariatric Surgery for Adolescents

Rates of obesity among youth are on the rise. Bariatric surgery is sometimes considered as a treatment option for adolescents who have developed extreme obesity. Although it is becoming clear that adolescents can lose weight following bariatric surgery, there are numerous unanswered questions about the long-term effects of these operations on adolescents’ developing bodies and minds.

Experts in pediatric obesity and bariatric surgery recommend that surgical treatment only be considered when adolescents have tried for at least 6 months to lose weight and have not been successful. Candidates should be extremely obese (typically with BMI greater than 40), have reached their adult height (usually 13 or older for girls and 15 or older for boys), and have serious weight-related health problems, such as type 2 diabetes, sleep apnea, heart disease, or significant functional or psychosocial impairment. In addition, potential patients and their parents should be evaluated to see how emotionally prepared they are for the operation and the lifestyle changes they will need to make. Patients should be referred to specialized adolescent bariatric surgery centers with a team of experts qualified to meet their unique needs.

A growing body of research suggests that both weight and health of extremely obese youth can be favorably changed by bariatric surgery. Over the years, gastric bypass surgery has been the predominant operation used to treat adolescent extreme obesity. An estimated 2,700 adolescent bariatric surgeries were performed between 1996 and 2003 (Arch Pediatr Adolesc Med. 2007;161:217–221). A review of short-term data from the national inpatient sample (the largest inpatient database in the United States) suggests that these operations are at least as safe for adolescents as adults. As yet, the adjustable gastric band has not been approved for use in the United States for people younger than age 18, but favorable weight-loss outcomes following adjustable gastric banding for adolescents have been reported internationally.