Is Bariatric Surgery an Option for Teenagers?

For teenagers struggling with obesity, treatment can offer long-term benefits. In the most severe cases of teenage obesity, bariatric surgery (or weight loss surgery) is one potential option.

Weight loss surgery for teenagers can help lead to lasting long-term weight loss. It can also help improve or even get rid of some of the chronic health issues obesity may cause.

Yet only a small percentage of teenagers who can get weight loss surgery do so.

“It’s important that people understand and know the up-to-date results of bariatric surgical treatment in this population,” says Anita Courcoulas, MD, director, UPMC Bariatric Services, and chief, Minimally Invasive Bariatric and General Surgery, University of Pittsburgh School of Medicine. “It has a significant impact on their lives and their future health.”

Learn more about obesity in teenagers and its treatment options.

Obesity in Teenagers

Obesity is a major problem for American children, adolescents, and teenagers.

According to the Centers for Disease Control and Prevention (CDC), 19.7% of Americans between 2 and 19 years old are obese. The percentage of 12- to 19-year-olds who are obese is even higher, at 22.2%. Some teenagers, such as Hispanic and non-Hispanic Black teenagers, face a higher risk than others.

Obesity is a problem because it can lead to other health risks. These can include type 2 diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, anxiety, depression, and more. Without treatment, these can become long-term health problems.

Also, without treatment, obese young people are more likely to stay obese when they’re adults.

“It’s a significant epidemic that requires effective treatment options,” Dr. Courcoulas says.

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Obesity Treatment for Teenagers Without Surgery

Treatment for teenage obesity without surgery is a lot like what it is for adults. It usually begins with lifestyle changes, such as diet and exercise. Some medications — known as glucagon-like peptide-1 agonists, or GLP-1 agonists — may lead to further weight loss.

Dr. Courcoulas says young people can lose between 4% and 10% of their weight through lifestyle changes. Medication may help boost that total by 10% to 20% and also may help address related health problems like diabetes.

Bariatric Surgery for Teenagers

If treatment without surgery doesn’t fully help with a teenager’s obesity, surgery may become an option.

Bariatric surgery requirements for teenagers

As it is for adults, teenagers who want to try bariatric surgery must have:

  • A body mass index (BMI) of 40 or above.
  • A BMI of 35 or above, along with a related health problem, such as type 2 diabetes, high blood pressure, or high cholesterol.

Surgeons will also consider the teenager’s growth, puberty, and mental readiness for surgery.

Bariatric surgery types for teenagers

The two most common types of surgery for teenagers are the same as they are for adults:

  • Sleeve gastrectomy or gastric sleeve. The surgeon removes part of the stomach, leaving a smaller stomach (or “sleeve”) behind. A smaller stomach makes you feel full more quickly and makes changes to your gut hormones.
  • Gastric bypass. This also shrinks your stomach and goes past part of your small intestine, so fewer calories stay in your system.

Gastric sleeve is more common than gastric bypass. It is simpler and leads to fewer risks. But for teenagers with type 2 diabetes and other issues, gastric bypass may prove the better option. Some studies show it leads to more weight loss and better control of how the body handles sugar, for example.

Lifestyle changes to things like diet and exercise are important after surgery. All obesity treatments start with them.

Dr. Courcoulas says they should begin before surgery. This part of a teenager’s treatment can last between 10 and 15 months. It allows time for testing, monitoring, and insurance approval.

“We use that time to help educate and make some of those lifestyle changes,” Dr. Courcoulas says. “Simple things such as reducing the frequency of snacking, type of snacking, removing carbonated beverages from the diet, exercising on a regular basis.” “All of those changes are really put in place before surgery. Then they undergo the operation, and they’re supported afterward to continue those changes.”

The Benefits of Bariatric Surgery for Teenagers

Bariatric surgery can lead to long-term weight loss of 25% to 35% for teenagers. It can also help with health problems such as diabetes, high cholesterol, high blood pressure, sleep apnea, and others.

“There is good multicenter data over the long term showing both the risks and benefits of bariatric surgery,” Dr. Courcoulas says.

UPMC was part of the 2019 multicenter Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. This study looked at the health effects of bariatric surgery in teenagers ages 14 to 19 compared to adults. The results (published in the New England Journal of Medicine) showed teenagers lost about as much weight as adults in the five years after their surgery.

“There is long-term data showing that people between the ages of 14 and 19 who undergo weight loss surgery can expect to lose weight in the same range that adults do,” Dr. Courcoulas says. “About 30% to 35% of their weight is lost with bariatric surgery. And the majority of people sustain that weight loss, so the weight loss is durable over time.”

Bariatric surgery may also help reduce or even eliminate related health conditions like high blood pressure, high cholesterol, or diabetes. The Teen-LABS study reported teenagers were more likely than adults to have remission of type 2 diabetes and high blood pressure after bariatric surgery.

Dr. Courcoulas says depression may also improve after surgery, though it can recur. They monitor patients over the long term for recurrence of depression.

What are the risks of bariatric surgery?

As with any surgical procedure, bariatric surgery carries risks. Those include:

  • Bleeding.
  • Blood clots.
  • Bowel problems (leaking, twisting, or kinking).
  • Heart attack.
  • Infection.
  • Pneumonia.

There is also a chance that a patient may need another operation. The Teen-LABS study reported there was a “significantly higher” rate of this among teenagers after bariatric surgery compared to adults.

Dr. Courcoulas says patients who have successful weight loss surgery may also tend to engage in risk-taking behavior, alcohol use, and substance use. Whether the surgery itself is the cause of this is unclear, but patients should undergo long-term monitoring for it.

Overall, the risk of complications from weight loss surgery is low but needs balancing against its weight and health benefits through shared decision-making.

Can Preteens Get Bariatric Surgery?

At UPMC, the minimum age for weight loss surgery is 14. There are some centers across the country and across the world that perform bariatric surgery on preteens. Early studies have shown that preteens can have the surgery and lose weight, but more research is necessary.

How Can Teens Seek Help for Obesity?

At UPMC, a multidisciplinary team of experts can help teenagers get the support they need to address their obesity. Our resources include the Weight Management and Wellness Center at UPMC Children’s Hospital of Pittsburgh and UPMC Bariatric Services.

If you’re a candidate for surgery, our teams will provide support both before and after your procedure.

Weight loss surgery may not work as the best option for every teenager. But it can help lead to long-term weight loss and better control of other health conditions. If you’re interested in bariatric surgery, learn more about our free information sessions.

“Obesity really significantly affects young people’s lives,” Dr. Courcoulas says. “I think that the surgical treatment of severe obesity in young people is here to stay. I also think it is probably best utilized in young people who have higher BMIs over 45 and have high risk of other health conditions.”

Centers for Disease Control and Prevention, Childhood Obesity Facts. Link

Thomas H. Inge, MD, PhD, Anita P. Courcoulas, MD, Todd M. Jenkins, PhD, et al, New England Journal of Medicine, Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. Link

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.