Posted September 23, 2022
dirk hoffman story
Steven E. Lipshultz, MD, A. Conger Goodyear Professor and Chairman of Pediatrics, is co-author of a new paper that validates the long-term efficacy and safety of metabolic and bariatric surgery (MBS) for the treatment obesity in adolescents.
“Long-Term Outcomes after Adolescent Bariatric Surgery,” published online Sept. 15 in the Journal of the American College of Surgeons, is the longest follow-up to the procedure published to date.
MBS is a safe and effective treatment option for adolescents with severe obesity, but no long-term studies with more than 10 years of follow-up data to document lasting improved results were previously available, according to Lipshultz, chief of Pediatric Service at Kaleida Health, Medical Director of Pediatric Service Business Development at Oishei Children’s Hospital and President and CEO of UBMD Pediatrics.
Longest follow-up of adolescent patients with MBS
In the new study, a total of 96 patients who completed MBS at age 21 or younger at a tertiary academic center from 2002 to 2010 were contacted for a telehealth visit.
Body weight, comorbidity status, social/physical function status, and long-term complications were assessed 10 to 18 years after surgery.
“Our results show that among 96 severely obese adolescents, there is a sustained decrease in morbid conditions and risk of future clinically significant diseases,” says Lipshultz. “This is the longest follow-up of these patients that we know of. Our study also focused on an ethnically underrepresented high-risk population, Hispanic adolescents. A relatively normal lifestyle is present in these patients on long-term follow-up.
Lipshultz notes that the teen obesity epidemic continues to worsen despite increased awareness.
“As in adults, excess adipose tissue triggers multiple immunological and metabolic pathways resulting in serious comorbidities such as impaired glucose tolerance or even type 2 diabetes, dyslipidemia, high blood pressure, fatty non-alcoholic liver disease and hyperuricemia,” he says.
MBS is evolving from being a controversial issue
The management of severe childhood obesity requires a lifelong, multidisciplinary approach with a combination of lifestyle, nutrition, and medication changes.
Standardized lifestyle intervention programs remain the first-line treatment for morbidly obese children and adolescents, but unfortunately show limited long-term success, notes Lipshultz.
“In such cases, metabolic bariatric surgery has moved from being a controversial issue to being included in separate guidelines,” he says.
“Although there is a better understanding of the role of metabolic bariatric surgery in the treatment of adolescent obesity, a number of barriers still prevent its widespread use,” adds Lipshultz.
“The lack of formal obesity-focused education in continuing medical education for primary and specialty care providers, coupled with a variable distribution of comprehensive resources, creates an inhospitable environment for effective adolescent obesity treatment and reluctance to refer for surgery.”
The study took over two decades to complete
Racial disparities and variability in insurance coverage also contribute to the complexity of the issue, Lipshultz notes.
“These recently published results show that metabolic bariatric surgery in adolescents is effective and durable with long-term follow-up,” he says. “In addition, we directly address issues of safety and effectiveness of metabolic and bariatric surgery in adolescents related to racial disparities.”
The study showed that patients with high cholesterol, asthma, and diabetes/hyperglycemia before surgery reported 100% remission at follow-up (these were statistically significant with p<0.05 for all).
Decreases following surgery in hypertension, sleep apnea, gastroesophageal reflux disease, anxiety and depression were also found to be statistically significant, according to Lipshultz.
“This study took more than 20 years to conduct, but should provide the evidence needed to guide providers, patients and their families, and insurers in decisions to offer severely obese adolescents metabolic and bariatric surgery, because Significant and sustained reductions in weight and comorbidities, and low rates of long-term complications, a decade or more after completing metabolic bariatric surgery in adolescence, were found,” he says.
Oishei Host to Healthy Weigh Program
Lipshultz notes that Oishei Children’s Hospital has a comprehensive program for overweight, obese, or morbidly obese children called Healthy Weigh.
The program is surgically led by Carroll M. Harmon, MD, PHD, John E. Fisher Chair in Pediatric Surgery, Chief of the Division of Pediatric Surgery at the Jacobs School of Medicine and Biomedical Sciences and Chief of Pediatric Surgery at Oishei Children’s Hospital. and Chief of Surgery at Kaleida Health.
“This program provides multidisciplinary care for these patients,” says Lipshultz. “This new publication suggests that the surgical management of these patients in Western New York is safe, effective, and available in our community.”
The study was led by first author Nestor de la Cruz-Munoz, MD, chief of the division of laparoendoscopic and bariatric surgery at the University of Miami Miller School of Medicine.
Sarah E. Messiah, PhD, MPH, professor of epidemiology, human genetics, and environmental sciences at the School of Public Health, University of Texas Health Science Center, and volunteer professor of pediatrics at the University of Miami Miller School of Medicine, was a senior author.
Lipshultz was chair of the University of Miami Miller School of Medicine’s Department of Pediatrics when the study began.
The researchers had organized a comprehensive program on childhood obesity which continues to be the subject of articles and a published book on pediatric metabolic syndrome.
In 2021, de la Cruz Munoz and Lipshultz published an invited comprehensive narrative review on the short- and long-term safety and effectiveness of bariatric surgery for severely obese adolescents, which was followed by publications from the American Academy of Pediatrics calling for better access to Pediatric metabolic and bariatric surgery for adolescents with severe obesity based on growing evidence and best practice.