Bariatric Surgery in Adolescents: To Do or Not to Do?

doi:10.3390/children8060453

Review

. 2021 May 27;8(6):453.

doi: 10.3390/children8060453.

Bariatric Surgery in Adolescents: To Do or Not to Do?

Valeria Calcaterra^{1

2}, Hellas Cena^{3

4}, Gloria Pelizzo⁵, Debora Porri^{3

4}, Corrado Regalbuto⁶, Federica Vinci⁶, Francesca Destro⁵, Elettra Vestri⁵, Elvira Verduci^{2

7}, Alessandra Bosetti², Gianvincenzo Zuccotti^{2

8}, Fatima Cody Stanford⁹

Affiliations

¹ Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy.
² Pediatric Department, "V. Buzzi" Children's Hospital, 20154 Milan, Italy.
³ Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy.
⁴ Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
⁵ Pediatric Surgery Department, "V. Buzzi" Children's Hospital, 20154 Milan, Italy.
⁶ Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy.
⁷ Department of Health Sciences, University of Milan, 20146 Milan, Italy.
⁸ "L. Sacco" Department of Biomedical and Clinical Science, University of Milan, 20146 Milan, Italy.
⁹ Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.

PMID: 34072065
PMCID: PMC8204230
DOI: 10.3390/children8060453

Review

Bariatric Surgery in Adolescents: To Do or Not to Do?

Valeria Calcaterra et al. Children (Basel). 2021.

. 2021 May 27;8(6):453.

doi: 10.3390/children8060453.

Authors

Affiliations

¹ Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy.
² Pediatric Department, "V. Buzzi" Children's Hospital, 20154 Milan, Italy.
³ Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy.
⁴ Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
⁵ Pediatric Surgery Department, "V. Buzzi" Children's Hospital, 20154 Milan, Italy.
⁶ Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy.
⁷ Department of Health Sciences, University of Milan, 20146 Milan, Italy.
⁸ "L. Sacco" Department of Biomedical and Clinical Science, University of Milan, 20146 Milan, Italy.
⁹ Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.

PMID: 34072065
PMCID: PMC8204230
DOI: 10.3390/children8060453

Abstract

Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

Keywords: adolescents; bariatric surgery; complications; laparoscopic sleeve gastrectomy; multi-disciplinarity; nutritional status; pediatric obesity; weight loss.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Potential mechanisms of sleeve gastrectomy for reducing body weight and improving metabolism. GLP-1: glucagon-like peptide 1; PYY: peptide YY.

See this image and copyright information in PMC

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References

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[1] Skinner A.C., Ravanbakht S.N., Skelton J.A., Perrin E.M., Armstrong S.C. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. 2018;141:e20173459. doi: 10.1542/peds.2017-3459. - DOI - PMC - PubMed

[2] Skinner A.C., Ravanbakht S.N., Skelton J.A., Perrin E.M., Armstrong S.C. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. 2018;141:e20173459. doi: 10.1542/peds.2017-3459. - DOI - PMC - PubMed

[3] Center for Disease Control and Prevention. [(accessed on 2 April 2021)]; Available online: https://www.cdc.gov/nchs/products/index.htm.

[4] Center for Disease Control and Prevention. [(accessed on 2 April 2021)]; Available online: https://www.cdc.gov/nchs/products/index.htm.

[5] Reilly J.J., Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Systematic review. Int. J. Obes. 2011;35:891–898. doi: 10.1038/ijo.2010.222. - DOI - PubMed

[6] Reilly J.J., Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Systematic review. Int. J. Obes. 2011;35:891–898. doi: 10.1038/ijo.2010.222. - DOI - PubMed

[7] Twig G., Tirosh A., Leiba A., Twig G., Tirosh A., Leiba A., Levine H., Ben-Ami Shor D., Derazne E., Haklai Z., et al. BMI at Age 17 Years and Diabetes Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents. Diabetes Care. 2016;39:1996–2003. doi: 10.2337/dc16-1203. - DOI - PubMed

[8] Twig G., Tirosh A., Leiba A., Twig G., Tirosh A., Leiba A., Levine H., Ben-Ami Shor D., Derazne E., Haklai Z., et al. BMI at Age 17 Years and Diabetes Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents. Diabetes Care. 2016;39:1996–2003. doi: 10.2337/dc16-1203. - DOI - PubMed

[9] Leopold S., Zachariah J.P. Pediatric Obesity, Hypertension, Lipids. Curr. Treat Options Pediatr. 2020;6:62–77. doi: 10.1007/s40746-020-00188-2. - DOI - PMC - PubMed

[10] Leopold S., Zachariah J.P. Pediatric Obesity, Hypertension, Lipids. Curr. Treat Options Pediatr. 2020;6:62–77. doi: 10.1007/s40746-020-00188-2. - DOI - PMC - PubMed

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Bariatric Surgery in Adolescents: To Do or Not to Do?

Affiliations

Bariatric Surgery in Adolescents: To Do or Not to Do?

Authors

Affiliations

Abstract

Conflict of interest statement

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