Pros and cons of bariatric surgery in adolescents

The global prevalence of overweight and obesity combined escalated by about 47% in children and adolescents between 1980 and 2013.1 About 30% of adolescents in the USA and 22–25% in Europe are overweight or obese.2 Overweight and obese adolescents show a high prevalence of cardiometabolic risk factors, including high levels of cholesterol, triglycerides, blood pressure, fasting blood glucose, and HbA1c, as well as hypertension, nonalcoholic fatty liver disease, and metabolic syndrome.3,4 Most cases of diabetes in children and young adults are now type 2 diabetes rather than type 1, and the rate of progression of macrovascular complications in young people with type 2 diabetes is higher than in those with type 1 diabetes.4 Unfortunately, hypocaloric diet, lifestyle modifi cation, and medical treatment do not have much of an eff ect in adolescent populations because of poor adherence. Additionally, intensive behavioural weight loss interventions that are eff ective at reducing BMI in adolescents who are overweight or obese have diminished eff ectiveness for those with severe obesity.5 In a randomised trial,6 orlistat (120 mg daily) in combination with a hypocaloric diet, behavioural therapy, and physical exercise led to modest weight loss at 1 year (at least a 5% decrease in BMI was reported in 26·5% of patients in the orlistat group vs 15·7% in the placebo group; p=0·005), with mild-to-moderate gastrointestinal adverse events occurring in 9–50% of patients. Furthermore, the 3-month reduction in BMI obtained with exenatide is modest (2·7%, 95% CI −5·02 to −0·37; p=0·025) and associated with side-eff ects such as nausea (62%), abdominal pain (15%), diarrhoea (8%), and vomiting (31%).7