In a national sample of ethnically diverse, severely obese adolescents, 1 year after bariatric surgery, weight and other anthropometric measures had decreased by the same amount in all racial/ethnic groups and in both sexes. Mean estimated weight loss for all three groups at 1 year differed by a maximum of only 1.5 kg. Surgery resulted in an average weight loss of more than 30 kg per person, a loss that far exceeds those reported in non-surgical weight-management programs[21
Among adults, ethnicity predicts better weight loss outcomes after bariatric surgery, with some studies reporting better outcomes among NHWs than among NHBs. There is little information about outcomes in Hispanics. Harvin et al[13
] found that 2 years after undergoing bariatric surgery, NHW adults had lost significantly more weight than did their ethnic group counterparts. Similarly, Buffington et al[15
] found that NHB adults had less-successful weight outcomes after gastric bypass than did NHW adults. Among adults, NHB women lost considerably less weight after surgery than did NHW women[13
]. Additionally, in the Netherlands, Admiraal et al[22
] found that African, South Asian, Turkish and Moroccan patients lost less weight at 1-year post-gastric bypass surgery versus their ethnic Dutch counterparts.
Conversely, most studies of adolescent bariatric surgery are case series from a single-institution, resulting in samples that are generally small and relatively homogeneous, which does not permit robust comparisons among ethnic groups[8
]. Although race and ethnicity are independently associated with cardiometabolic disease risk[23
], we found that weight loss was similar among all three ethnic groups and varied more among boys than among girls. However, no overall pairwise group comparisons were significant, indicating that no ethnic group had better weight loss outcomes than did another, unlike comparisons of adults, as described above. Parental influence over post-operative adherence to quality nutrition and physical activity recommendations may partially explain the lack of ethnic group differences.
Although the childhood obesity epidemic continues unabated in most developed countries, non-surgical approaches to the long-term (1 year or more) management and decrease of overweight in childhood have had limited success[21
]. Despite standardized indications for bariatric surgery in adolescents[25
], obese children are not simply younger versions of obese adults; they are still developing and growing, both physically and psychologically. Extreme obesity should be treated sooner rather than later[8
], particularly in adolescents, who may have not yet developed full-blown, related comorbidities, such as diabetes or heart disease. Our analysis found that type of surgery significantly influences weight loss, however and thus must be a consideration for adolescents considering this alternative; gastric bypass surgery resulted in significantly more weight loss at 1-year versus adjustable gastric band surgery. Therefore, gastric bypass may be a viable option for those who are in need of more weight loss to resolve co-morbidities that have already developed. However, the optimal age in adolescence for bariatric surgery is as yet undetermined[24
]. Our findings, and those of others[26
] indicate that bariatric surgery before adulthood can substantially reduce weight[10
] and resolve comorbidities[25
]. Moreover, earlier treatment of obesity may prevent later costs. For example, children and adolescents with a primary or secondary diagnosis of overweight, obesity, or severe obesity require longer hospital stays than do children without these diagnoses[28
Even as the emerging data on bariatric surgery-including those from randomized-controlled trials[26
] -continue to show important long-term weight loss and improvement in most obesity-related comorbidities, many pediatric specialists still hesitate to refer patients for surgery[30
]. A survey of several hundred pediatricians in the United States showed that, although they believed pediatric obesity to be a major problem, less than half would be somewhat or very likely to refer a severely obese adolescent for surgery[30
]. Yet, the medical consequences of childhood obesity continue and suggest that overt disease beginning in early adulthood may become chronic[31
Limitations of the study
Our findings and conclusions are limited by a substantial amount of missing follow-up data, a common problem in the bariatric literature among both adults and adolescents. Older adolescents in particular are difficult to follow because they may leave the geographic area for education or employment. More age-relevant tracking procedures, such as those based on social media or handheld or cellular telephone devices, may be able to decrease losses to follow-up.
Variations in practice management among BSCOE participants may delay data entry, potentially resulting in incomplete follow-up data. Additionally, pre-surgical information on nutritional deficiencies is not available to determine whether surgery is the cause of the few deficiencies we found or whether these deficiencies existed before surgery.
Our results support the conclusion that bariatric surgery can substantially reduce weight in severely obese adolescents for at least 1 year, irrespective of their race or ethnicity. Ethnicity should not be a contraindication for bariatric surgery in adolescents, which is a reasonable and safe treatment for all severely obese adolescents with the appropriate indications.