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Comparative Effectiveness Review of Bariatric Surgeries for Treatment of Obesity in Adolescents

January 21, 2019

Health Problem: Child and adolescent obesity is a body mass index (BMI) at or above the sex-specific 95th percentile on BMI-for-age growth charts. Consequences of obesity in children and adolescents include type 2 diabetes mellitus, obstructive sleep apnea, hypertension, nonalcoholic fatty liver disease, hyperlipidemia, musculoskeletal disorders, endocrine conditions, psychological and psychosocial issues, and high risk of progression to adult obesity.

Technology Description: Bariatric surgery refers to the surgical treatment of severe obesity through procedures that reduce the size of the stomach to restrict caloric intake and/or change the intestinal anatomy to induce malabsorption. The surgical procedures most commonly used in adolescents are Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric band; these procedures are usually performed via a laparoscopic approach.

Controversy: Controversial issues related to the use of bariatric surgery in adolescents with obesity include patient selection, procedure selection, patient adherence to lifestyle interventions and nutritional supplementation, risk of procedural complications, and long-term safety and efficacy (e.g., impact on morbidity, mortality, and quality of life; need for reoperation).

Key Questions:

  • Is bariatric surgery effective in treating severe obesity in adolescents?
  • How does bariatric surgery compare with nonsurgical interventions in treating severe obesity in adolescents?
  • How do different bariatric surgery procedures compare with each other in treating severe obesity in adolescents?
  • Is bariatric surgery safe in adolescents with severe obesity?
  • Have definitive patient selection criteria been identified for bariatric surgery to treat obesity in adolescents?