Understanding Outcomes in Adolescent Bariatric Surgery

We live in an era of evidence-based medicine. Doctors are expected to be knowledgeable about the relative risks and benefits of different treatment options and to share that information with patients as part of their treatment decision-making. For an invasive procedure such as major surgery, both doctors and patients must consider a host of medical and psychological risks. Before patients agree to undergo an elective surgery, they may be asking themselves a number of questions, including, “Is this treatment right for me?” and “Will life be better afterwards—or worse?” Adolescents considering bariatric surgery are unable to answer these questions with the current evidence, because that evidence is inadequate. There are few longitudinal outcomes data. Moreover, patient-centered outcomes data that could inform clinicians and their young patients about adolescent experiences of surgery are missing from the clinical literature. The absence of these data means that surgical teams are treating severely obese adolescents with procedures that were developed and standardized with adults, without knowing the long-term impact on these patients’ lives.1 As a result, adolescents and their parents must take a giant leap of faith in their decision-making without knowing whether surgery will lead to permanent weight loss or to regain of weight and complications that have to be managed. This evidence gap matters because bariatric surgery could play a major role in treating severely obese adolescents who cannot lose weight.2 Although the growth rate of obesity in US children and adolescents has been leveling off since 2008, severe obesity is on the rise. … Address correspondence to Janet E. Childerhose, PhD, Center for Bioethics and Social Sciences in Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Rm 400S-24, Ann Arbor, MI 48109-2800. E-mail: childerh{at}umich.edu