Purpose: Bariatric surgery in adolescents is a commonly performed procedure in the United States. It is unclear if the difference in the extent of final weight loss, between patients, after metabolic surgery is secondary to dietary compliance, preoperative weight, metabolic differences, exercise habits, hormonal variations, or other unknown causes. To such end, we evaluated weight loss patterns in a cohort of obese (BMI>35) adolescents.
Methods:We retrospectively enrolled 57 adolescents (<21 years) who underwent laparoscopic sleeve gastrectomy from 2011-2017. Data collection included demographics, anthropometrics, comorbidities, and weight loss patterns over a 3-year follow up. For analysis, patients were stratified into two groups: obese (BMI<50, n=34) and super-obese (BMI≧50, n=23). Data was collected at months 1, 3, 6, 12, 36 after surgery. Statistical analysis was performed using Student’s t-test and repeated Measures ANOVA
Results:In BMI<50 group 82% were female while in BMI>50 52% were male (P<0.0059). While 13/34 patients in BMI<50 achieved >60% percent excess body weight loss (EBWL) only 3/23 BMI>50 achieved>60% EBWL (P= 0.0695). EBWL at 1-year follow-up significantly differed between the obese and super-obese groups, 61.7±14.6% and 47.7±14.9% respectively (p=0.035). A nadir was reached in both groups within a year with no significant weight-regain after 3 years. The average BMI in obese group was 29.8 at 1-year and 41.3 in the super obese group. There was a significant difference in the rate of excess weight loss (%EBWL/month) between the two groups (p<0.01). There was good comorbidity resolution (about 70%) in both groups after surgery.
Conclusion:If BMI<30 is the ideal goal after bariatric surgery, few patients in BMI>50 cohort achieve this after a restrictive operation such as a sleeve gastrectomy. However, if comorbidity resolution was the goal of metabolic surgery, a sleeve gastrectomy achieves that with lower complication profile in all patients.