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Comparative Study
. 2025 Jul:282:114564.
doi: 10.1016/j.jpeds.2025.114564. Epub 2025 Mar 23.

Metabolic and Bariatric Surgery Utilization in the Era of Glucagon-Like Peptide-1 Receptor Agonists among Adolescents versus Adults

Sarah E Messiah  1 , Deepali K Ernest  2 , Folefac D Atem  2 , Faisal G Qureshi  3 , M Sunil Mathew  4 , Jackson M Francis  4 , Alicia Wheelington  5 , Marlyn A Allicock  2 , Bethany R Cartwright  6 , Benjamin E Schneider  7 , Nestor de la Cruz-Muñoz  8 , Steven E Lipshultz  9 , Ildiko Lingvay  10 , Jaime P Almandoz  11 , Sarah E Barlow  12
Affiliations
Comparative Study

Metabolic and Bariatric Surgery Utilization in the Era of Glucagon-Like Peptide-1 Receptor Agonists among Adolescents versus Adults

Sarah E Messiah et al. J Pediatr. 2025 Jul.

Abstract

This cross-sectional study analyzed adolescent metabolic and bariatric surgery (MBS) utilization before and after glucagon-like peptide-1 receptor agonist (GLP-1RA) medication approval, comparing trends across race and ethnic groups. Although both MBS and GLP-1RA are effective weight management strategies, adolescent MBS utilization increased, while adult rates declined from 2021 through 2023.

Keywords: adolescents; adults; bariatric surgery; prevalence.

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Conflict of interest statement

Declaration of Competing Interest All phases of this study were supported by NICHD grant R21HD105129. The National Institute of Child Health and Human Development had no role in the study design, data collection, and analysis. S.E.M. is funded by the National Institutes of Health, National Institute on Minority Health and Health Disparities (grant #R01MD011686) and the National Institute of Child Health and Human Development (grant #R21HD105129). B.R.C. Cartwright reported receiving grant from the American Diabetes Association (grant #7-23-JDFT2DY-05). S.E.L. is supported in part by the US Department of Health and Human Services Health Resources and Services Administration, Rockville, MD (HRSA-C76HF15614-10679 Pediatric Integrative Medicine Research Center), the National Center for Toxicological Research (NCTR-E0728711), the National Institutes of Health (HL072705, HL078522, HL053392, CA127642, CA068484, HD052104, AI50274, CA127642, CA068484, HD052102, HD052104, HL087708, HL079233, HL004537, HL087000, HL007188, HL094100, HL109090, HL111459, HL095127, HD80002, HD028820), the Laura Coulter-Jones Foundation (Division of Pediatric Clinical Research), the Batchelor Foundation (Batchelor Children's Research Institute), the Children's Cardiomyopathy Foundation, Sofia's Hope, Inc, the Kyle John Rymiszewski Foundation, the Children's Hospital of Michigan Foundation, the Scott Howard Fund, and the Michael Garil Fund.

Figures

Figure 1.
Figure 1.
Frequency of MBS utilization among adults (≥20 years) and adolescents (13–19 years) from 2021 to 2023 (n = 4447). Trends in frequency of MBS completion from 2021 to 2023, among adults (gray line) and adolescents (red line). The adult group experienced an increase in MBS completion from 2021 (n = 209 829) to 2022 (n = 229 159). However, there was a subsequent decline in MBS completion from 2022 to 2023 (n = 216 323). The adolescent group experienced a consistent linear increase in the frequency of MBS completion from 2021 (n = 1376) to 2022 (n = 1490) to 2023 (n = 1581). Overall, MBS utilization significantly differed between adults and adolescents from 2021 to 2023 (P for trend = .003), with adults having consistently higher MBS utilization than adolescents.
Figure 2.
Figure 2.
Frequency of MBS utilization in adolescents by race and ethnicity groups. Note: The other/unknown race and ethnicity group includes adolescents who identified as non-Hispanic Asian, non-Hispanic American India/Native, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic mixed race, or other unknown race. The frequency of MBS utilization in adolescents, from 2021 to 2023, by self-reported race and ethnicity. Briefly, there was an increase in MBS utilization among non-Hispanic Black adolescents from 2021 (n = 266) to 2022 (n = 296) to (n = 316). A similar increase was observed among Hispanic adolescents from 2021 (n = 398) to 2022 (n = 511) to 2023 (n = 586). Those who identified as non-Hispanic White or other/unknown race and ethnicity had a decline in MBS completion from 2021 to 2023. Overall, MBS utilization among adolescents significantly differed by race/ethnicity groups from 2021 to 2023 (P for trend < .001).
Figure 3.
Figure 3.
Frequency of MBS utilization in adults by race and ethnicity groups. Note: The other/unknown race and ethnicity group includes adults who identified as non-Hispanic Asian, non-Hispanic American India/Native, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic mixed race, or other unknown race. The frequency of MBS utilization in adults, from 2021 to 2023, by self-reported race and ethnicity. Briefly, there was an increase in MBS utilization among non-Hispanic Black adults from 2021 (n = 41 851) to 2023 (n = 42 697) and Hispanic adults from 2021 (n = 32 668) to 2023 (n = 44 299). However, there was a decline in MBS utilization among non-Hispanic White adults from 2021 (n = 117 203) to 2023 (111 567), and other/unknown race from 2021 (n = 18 087) to 2023 (n = 17 760). Overall, MBS utilization among adults significantly differed by race/ethnicity groups from 2021 to 2023 (P for trend < .001).
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