Effectiveness of Bariatric Surgery Versus Lifestyle Weight Loss Interventions in Adolescents: A Long-Term Study of Weight Management and Nutrient Levels

Miri Mizrahi Reuveni, Bar Cohen, Dor Atias, Ilan Yehoshua, Limor Adler

Keywords: Obesity; Adolescents; Bariatric surgery; lifestyle weight loss intervention.

Background:

Obesity in children is a concern in medicine and public health. While bariatric surgeries are considered efficient for weight loss, their long-term effects on health remain debatable.

Research questions:

To compare outcomes of bariatric surgeries vs. traditional lifestyle-based weight loss program among adolescents.

Method:

This is a retrospective comparative study. Data was collected from one healthcare maintenance organization (HMO) in Israel. We followed individuals who underwent bariatric surgery before 18 in 2011-2021 (n=152) and were compared to a group of individuals with obesity and similar features who tried a lifestyle weight loss program (n=126). We collected data about weight, body mass index (BMI), and blood tests (TSH, hemoglobin, vitamin B12, vitamin D, and folic acid levels). We then performed linear mixed models to establish trends and compare between the groups.

Results:

We found the case group’s weight and BMI decreased in the two years following surgery, a trend which later plateaus. After surgery, this trend is statistically significant compared to the control group (p-value<0.001). This is reflected in the SDS of BMI and weight, which reduce over time while remaining stable in the control group (p-value<0.001). For hemoglobin levels, which started similarly in both groups, we detected a decrease in the case group over time, becoming statistically significant in the fourth year after surgery. Additionally, we detected a decrease in average vitamin B12 levels between the first and second year, which failed to rise to pre-op levels during the study period.

Conclusions:

We detected a decrease in weight consistent with literature on bariatric surgeries in children. We also detected nutritional trends, with possibly symptomatic consequences, in the years after surgery. They highlight the importance of long-term adherence and managing these patients with changed anatomy and physiology as they reach adulthood.

Points for discussion:

Bariatric surgeries in adolescents - pros vs. cons?

Long term outcomes of bariatric surgeries

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