Articles

Trends and Outcomes of Metabolic Surgery in Adolescents with BMI ≥ 50 vs <  50 kg/m2: A Retrospective Study Using the MBSAQIP Database. [1] Kachornvitaya P et al., Obes Surg. 2025 Sep;35(9):3686-3693. PMID: 40681925.

The efficacy of Metabolic and bariatric surgery (MBS) in adolescents has been established through multiple prospective and registry studies, including Teen-LABS and FABS-5+. Durable weight loss, rates of remission of co-morbidities exceeding that of adults and low perioperative morbidity have been thoroughly demonstrated. Considering this data, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American Academy of Pediatrics (AAP) have endorsed surgical intervention in carefully selected adolescents when non-operative therapies fail. To date, adolescents with extreme obesity (BMI ≥50 kg/m²) remain underrepresented in prior studies and disproportionately excluded from surgical referral. This is primarily due to evidence in the adult population demonstrating increased perioperative risk, longer operative times and higher complications rates in patients with BMI ≥50 kg/m². Existing adolescent datasets have either included too few patients in this BMI range or have not stratified outcomes by BMI category, leaving a critical gap in evidence regarding the short-term safety of MBS in the highest-risk adolescent subgroup.

This study utilizes the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to retrospectively review data from over 3,000 patients across nearly 1,000 accredited centers. Although adolescents with BMI ≥50 kg/m² suffered from significantly higher rates of obesity related co-morbidities and longer operative times, they experienced no increase in serious 30-day complications and no mortality when compared to adolescents with lower BMIs. Importantly in adolescents, BMI ≥50 kg/m² was not an independent predictor of adverse outcomes in contrast to findings in the adult population. Primary predictors of serious complications elicited in this study included the presence of type 2 diabetes and Roux-en-Y gastric bypass, rather than extreme BMI. This study reframes perioperative risk assessment in adolescent bariatric surgery, supporting broader surgical consideration and earlier referral for adolescents with extreme obesity. This study provides critical safety data that can be used to inform clinical guidelines, payer policies, and family counseling. Additionally, this study fills a key evidentiary gap and complements long-term efficacy studies by establishing that metabolic surgery is not only effective but also safe in the adolescents at highest risk for obesity-related morbidity and premature mortality.

Ten-Year Outcomes after Bariatric Surgery in Adolescents.[2] Ryder JR et al., N Engl J Med. 2024 Oct 31;391(17):1656-1658. PMID: 39476348.

Severe obesity in adolescents is associated with increased risk of type 2 diabetes, hypertension, and dyslipidemia, among other health complications. Bariatric surgery has been shown to be an effective intervention for weight loss and comorbidity improvement in both adults and adolescents. In adults, long-term remission rates for type 2 diabetes following bariatric surgery are modest, with only 12–18% achieving remission after 7–12 years. Prior reports from the Teen-LABS study demonstrated substantial early weight loss and improvement in obesity-related comorbidities in adolescents undergoing bariatric surgery, but long-term outcomes beyond 5 years were less well documented.

This 10-year follow-up of the Teen-LABS cohort provides the longest prospective multicenter data on adolescents undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Both surgical procedures resulted in durable and clinically meaningful weight loss (approximately 20% BMI reduction maintained at 10 years). Early postoperative weight loss (at 6 months) was strongly predictive of long-term BMI trajectory. Remission rates for comorbidities at 10 years were substantial: 55% for type 2 diabetes, 57% for hypertension, and 54% for dyslipidemia, independent of weight loss/regain. This superior to long-term outcomes typically observed in adults and strong evidence for earlier intervention. The study highlights heterogeneity in response but overall supports bariatric surgery as a highly effective and durable treatment for adolescents with severe obesity, especially in the presence of co-morbidities.

PFAS Exposure and Postoperative Weight Regain in Adolescents After Bariatric Surgery: Findings From the Teen-LABS Study. [3] Baumert BO et al., Obesity (Silver Spring). 2025 Oct;33(10):1930-1954. Epub 2025 Aug 14. PMID: 40808486.

· Severe obesity in adolescents is rising and is strongly linked to adverse long-term health outcomes such as type 2 diabetes, cardiovascular disease, and reduced quality of life.

· Bariatric surgery is the most effective intervention for severe obesity in adolescents, producing substantial weight loss and comorbidity improvement. However, many patients experience weight regain after the first postoperative year, which reduces the durability of benefits.

· Environmental exposures, including per- and polyfluoroalkyl substances (PFAS), are widespread, persistent, and associated with metabolic dysregulation in adults.

· In adult populations, higher PFAS concentrations have been linked to reduced weight loss and greater weight regain following dietary interventions, possibly through mechanisms involving lipid metabolism, adipogenesis, mitochondrial dysfunction, and hormonal regulation.

· Among PFAS subtypes, sulfonic acid–containing congeners (PFSAs, e.g., PFOS, PFHxS) are more bioaccumulative, have longer half-lives, and may exert stronger metabolic effects than carboxylic acid congeners (PFCAs, e.g., PFOA, PFHpA).

· The impact of PFAS on postoperative weight outcomes in adolescents, particularly after bariatric surgery, has not been previously studied.

This is the first study to examine the association between baseline PFAS concentrations and long-term weight outcomes in adolescents undergoing bariatric surgery (Teen-LABS cohort, 5-year follow-up).

· Higher baseline concentrations of PFSAs (PFOS, PFHxS, PFHpS) were associated with:

Greater BMI regain during years 1–5 post-surgery.

Reduced percent weight loss over the same period.

Increased waist circumference, particularly with PFHxS exposure.

· The effects appeared concentration-dependent, with higher PFAS levels predicting steeper rates of weight regain (e.g., BMI regain of 1.3–1.8 kg/m² per year for high PFOS/PFHxS exposure).

· Mixture analyses confirmed that PFSAs as a group were positively associated with adverse weight outcomes, while some PFCAs (e.g., PFHpA, PFDA) showed inverse or protective associations.

· These findings suggest that environmental PFAS exposure may undermine the long-term benefits of bariatric surgery in adolescents, representing a modifiable and under-recognized risk factor for weight regain.

· Clinical and public health implications include the potential for PFAS reduction strategies (e.g., dietary choices, PFAS-free products, regulatory interventions) to support better long-term outcomes after bariatric surgery.

· Highlights the importance of integrating environmental health considerations into obesity treatment and calls for future mechanistic studies, repeated PFAS measurements, and intervention trials.

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