Bariatric surgery to reverse metabolic syndrome in adolescents

Adolescent obesity is a public health crisis with serious immediate and long-term health consequences. Currently, prevention is the best solution, but this may prove difficult in a world with a growing epidemic of childhood obesity. Bariatric surgery is the only proven intervention that provides sustained weight loss as well as improvement and resolution of obesity-related comorbidities. Prior to any surgical intervention, patients must go through a comprehensive evaluation phase. Available procedures are either restrictive or malabsorptive, with the most common being the Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. With the advent of laparoscopy, hospital stays have become short, but postoperative complications can still occur. The risks and benefits of operating on these obese adolescents with multiple comorbid conditions must be weighed and thoroughly discussed with patients and their families. According to published studies, there is a proven benefit to obese adolescents, even though most patients do not reach their ideal body weight. Almost all experience an improvement or resolution of comorbid conditions such as metabolic syndrome, diabetes, hyperlipidemia, hypertension, and sleep apnea. These results could have significant, long-lasting benefits on the adolescent patient. Given the young age of these patients, there should be an emphasis on a multidisciplinary approach in their treatment in order to improve compliance. Bariatric surgery appears to be the most effective means of achieving sustained weight loss with improvement or resolution of obesity-related comorbidities in the adolescent population.