Growing number of US adolescents receive weight-loss surgery

Weight-loss surgeries for adolescents increased 15% in the U.S. between 2021 and 2023, even as the Food and Drug Administration (FDA) approved effective new weight-loss medications for this age group, a study led by UT Southwestern Medical Center researchers shows. Their findings, published in The Journal of Pediatrics, shed light on how severe obesity is being treated in teenagers, the fastest-growing age group with this condition.

“The number of U.S. adolescents having access to this treatment that we know is safe and effective is the highest it’s ever been, and hopefully it’s the start of a positive weight loss journey that will get them to better health,” said Sarah Messiah, Ph.D., M.P.H., Professor of Epidemiology and Associate Dean for Research in the Peter O’Donnell Jr. School of Public Health. She’s also a Professor of Pediatrics and Director of the Child and Adolescent Population Health Program at UT Southwestern. Dr. Messiah co-led the study with Sarah Barlow, M.D., M.P.H., Professor of Pediatrics at UTSW.

In 2018, the combined prevalence of Class II and III obesity was 9.1% among U.S. adolescents. Such severe obesity is associated with a host of health issues, including heart, liver, and kidney disease, sleep apnea, and mental health problems.

Metabolic and bariatric surgery (MBS)—a category of operations that include gastric sleeve, gastric band, and gastric bypass—is considered the gold standard for sustained weight loss and decreased risk of obesity-related health problems in both adolescents and adults.

However, a new class of weight-loss drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RAs) has exploded in popularity since semaglutide became FDA-approved for adults in June 2021, followed by approval for adolescents in December 2022.

These drugs help patients achieve a loss of 15%-20% of baseline body weight, offering a noninvasive alternative to MBS. However, Dr. Messiah said, they aren’t yet covered by Medicaid for obesity treatment in most states, including Texas, and have limited coverage by private insurance, making them more costly and difficult to obtain.

To better understand MBS utilization with the advent of weight-loss medications, Dr. Messiah, Dr. Barlow, and their colleagues relied on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use files, a database that holds information from the nearly 1,000 medical centers accredited in the U.S. to perform MBS.

The researchers gathered data on how many adolescents (ages 13-19) and adults received MBS between 2021 and 2023, the years before, during, and after GLP-1RAs became FDA-approved for adolescents. They also collected demographic information on these patients.

Their findings showed MBS increased among adolescents over this time span, from 1,376 patients in 2021 to 1,581 in 2023. The mean age decreased slightly during this time, from 17.91 to 17.79. Gastric sleeve operations dominated these procedures, representing more than 86% of all the surgeries performed.

Although MBS rose among adults between the first two years, from 209,829 procedures in 2021 to 229,159, they dropped to 216,323 in 2023. The researchers hypothesized that this decrease was due to more adult patients opting to take GLP-1RAs instead of having surgery.

This study is the first to show that much of the rise in adolescent MBS was due to an increase in this procedure among Hispanic and non-Hispanic Blacks, ethnic and racial groups disproportionately affected by severe obesity compared to their non-Hispanic white counterparts.

Less encouraging was the finding that about one-third of adolescents undergoing MBS had a body mass index (BMI) over 50, she added. Intervening with MBS earlier could have helped these patients lower their BMI at younger ages, reducing their risk of associated health problems over time.

“Severe obesity is very common, much more common than it should be, and it is unlikely to respond to lifestyle interventions alone. I think the relative number of bariatric surgeries is still pretty low, given the potential benefit and need among kids,” Dr. Barlow said.

Looking to the future, treatment for severe obesity is likely to involve MBS and weight-loss medications as well as lifestyle support to achieve long-term health, researchers note.