Bariatric, Metabolic Procedures on the Rise in US Youth and Adolescents

New research from the University of Texas Houston School of Public Health is underlining the increasing popularity and decreasing number of barriers to metabolic and bariatric surgery among US youth.

An analysis of data from 2015-2021, results of the study suggest metabolic or bariatric surgery increase among US youth and among most racial/ethnic groups during the study period, with a dramatic increase in 2020-2021 despite the rates among their adult counterparts decreasing in 2020.

“Use of and access to [metabolic and bariatric surgery] have increased among US youth and among most racial and ethnic groups. Compared with 2015-2019, [metabolic and bariatric surgery] use in youths increased significantly in 2020-2021 during the first 2 years of the COVID-19 pandemic,” wrote investigators. “In contrast, [metabolic and bariatric surgery] rates in adults decreased in 2020. The [American Academy of Pediatrics] has highlighted the need to educate pediatricians about the benefits of MBS for qualified patients.”

In the last 40 years, bariatric and metabolic surgery has gone from a final effort to address severe obesity, to a safe, reliable option for inducing weight loss, with the American Academy of Pediatrics (AAP)’s 2023 guidelines endorsing surgery as an option to consider among teens aged 13 years or older with severe obesity. Citing rising rates of obesity in youth, Sarah Messiah, PhD, and a team of colleagues sought to examine how a policy statement released by the AAP in 2019 calling for increased adolescent access to metabolic and bariatric surgery when medically indicated might have influenced rates of bariatric or metabolic surgery among youth in the US.

With this in mind, investigators designed their study as an analysis of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Using 2015-2021 as a period of interest, investigators obtained participant use files from 1,346,468 individuals who underwent bariatric or metabolic surgery prior to turning 19 years of age. This cohort had a mean age of 44.9 (SD, 11.9) years, 91.1% were female, 18.9% were male, 16.9% were Black, 9.7% were Hispanic, 57.4% were White, and 15.9% were of other races and ethnicities, multiracial, or of unknown race and ethnicity.

Upon analysis, investigators found the completion rates for metabolic and bariatric surgery increased from pre-AAP statement release through 2021, with increases seen for the overall cohort and for each ethnic subgroup (P <.001). Further analysis indicated a greater number of youths and adults completed metabolic surgery in 2021 than in 2020, which resulted in 18.85% and 24.36% year-to-year increases in metabolic and bariatric surgery rates, respectively. Investigators pointed out, during 2021, metabolic and bariatric surgery completion increased from 182 to 258 procedures in Black youths, from 179 to 273 procedures in Hispanic youths, and from 459 to 518 procedures in White youths (P for trend <.001 for all).

“The [American Academy of Pediatrics] has highlighted the need to educate pediatricians about the benefits of MBS for qualified patients.Historically, MBS has been underused in youths due to barriers, including low referral rates, limited access, and poor insurance coverage,” wrote investigators. “In a recent study, our research group reported sustained weight, comorbidity reductions, and low long-term complication rates a decade after MBS in patients aged 15 to 21 years.”

References:

1. Messiah SE, Xie L, de la Cruz-Muñoz N, Lipshultz SE. Use of Metabolic and Bariatric Surgery Among US Youth. JAMA Pediatr. Published online May 30, 2023. doi:10.1001/jamapediatrics.2023.0803
2. Campbell P. Comprehensive study, boasting 40 years of follow-up, underlines long-term benefits of bariatric surgery. HCP Live. February 10, 2023. Accessed May 30, 2023. https://www.hcplive.com/view/study-40-years-follow-up-long-term-benefits-of-bariatric-surgery.
3. Campbell P. American Academy of Pediatrics Debuts Historic Pediatric Obesity Guidelines. HCP Live. January 9, 2023. Accessed May 30, 2023. https://www.hcplive.com/view/american-academy-of-pediatrics-debuts-pediatric-obesity-guidelines.