[Bariatric surgery in obese adolescents: When and how should the transition from pediatric to adult medical management be made?]

Bariatric procedures including Roux-en-Y gastric bypass in French adolescents

INTRODUCTION

In France, approximately 100 obese adolescents undergo a bariatric procedure every year. To date, only data from laparoscopic adjustable gastric banding (LAGB) or sleeve gastrectomy (SG) have been published. Our objective was to report the outcomes of a series of French obese adolescents who underwent a Roux-en-Y gastric bypass (RYGB).

METHODS

We included all obese adolescents aged 13-19 years who underwent RYGB in our department from 2008 with at least 2 years of follow-up after surgery. We analyzed the course of the anthropometric data, comorbidities, and subsequent adverse events.

RESULTS

Starting in September 2008, out of 93 obese adolescents who requested bariatric surgery, 39 (35%) underwent a bariatric procedure. From these adolescents, 2-year follow-up data were available for 26 patients who had a RYGB. At the time of surgery, the mean patient age was 17.4 years (standard deviation [SD]=1.4) and the body mass index (BMI) was 52.0 kg/m² (SD=7.8). One patient was lost to follow-up. At 2 years after surgery,  the mean BMI was 35.7 kg/m² (SD=9.4) with a mean decrease in BMI of 31.9% (SD=11.6). Comorbidities improved for most of the patients: high blood pressure (2/2) and pseudotumor cerebri (1/1) were cured after surgery, and dyslipidemia improved globally. The complications observed were anemia, abdominal pain requiring celioscopy (n = 2), and oxalic nephrolithiasis.

CONCLUSION

Only one third of the obese adolescents requesting bariatric surgery were operated on. Our series including exclusively obese adolescents who underwent an RYGB presents the results of this technique on weight loss and comorbidities; mechanical and nutritional complications remain uncommon. These results are similar to those obtained in studies of adult patients.

Cirugía bariátrica en pediatría, ¿qué impacto tiene? Revisión de la literatura

Introducción. La obesidad en la población pediátrica ha ido aumentando de manera progresiva y el manejo médico de la obesidad mórbida en esta población se ha mostrado insuficiente. El objetivo de este artículo fue describir el estado actual de la literatura científica publicada hasta abril 15 de 2021 sobre el impacto de la cirugía bariátrica en la población pediátrica. Métodos. Se realizó una revisión de la literatura que evaluó dos bases de datos, donde se incluyeron revisiones sistemáticas, reportes de casos, series de casos y ensayos clínicos, publicados desde el 1 de enero de 2010 hasta el 15 de abril de 2021, en español, inglés y francés. Resultados. Se incluyeron 56 documentos y 18 estudios clínicos, en los que se encontró que la cirugía bariátrica (bypass gástrico por Y de Roux, gastrectomía en manga, plicatura gástrica y banda gástrica) alcanzó una pérdida de peso significativa en el primer año, con un adecuado sostenimiento de dicha pérdida al quinto año, además de una resolución completa de las comorbilidades metabólicas y cardiovasculares en la mayoría de los pacientes. Conclusión. La cirugía bariátrica se presenta como una alternativa eficaz en el manejo de la obesidad mórbida y sus complicaciones en el paciente pediátrico

Recent advances in the modification of taste and food preferences following bariatric surgery

There is a large body of evidence indicating that bariatric surgery provides durable weight loss and health benefits to patients who are obese and have comorbidities such as type 2 diabetes (T2D). However, there are still many questions related to mechanisms of metabolic improvement, predictors of success/failure, and long term consequences, which need to be answered. More recently, there has been a particular interest in the modulation of taste and food preferences that occurs after bariatric surgery and how this affects weight loss in different individuals. Animal models as well as human studies have shed some light on the role of taste in changing food preferences and how these changes may affect weight loss after surgery. The goal of this review is to discuss the physiological and behavioral consequences of bariatric surgery as a treatment for obesity and T2D, with particular emphasis on recent studies describing bariatric surgery-induced modifications in taste perception and food preferences.