Adolescents with obesity who underwent bariatric surgery (BS) show substantial and sustained improvements in BMI and cardiometabolic health, according to a study.
The benefits of BS are also consistent across socioeconomic position (SEP) and ethnic groups, highlighting the importance of equitable access to comprehensive bariatric care.
“Adolescent BS was associated with sustained improvements in BMI and cardiometabolic risk factors in a large real-world cohort, supporting its long-term effectiveness across population subgroups,” the investigators said.
A total of 1,035 adolescents (median age at surgery 18.6 years, 69.7 percent female) were included in this retrospective cohort study, and the most common procedure among these individuals was sleeve gastrectomy (SG). [Obesity 2026;34:1477-1492]
“Owing to its relative technical simplicity and lower risk of micronutrient deficiencies compared with Roux-en-Y gastric bypass (RYGB), SG is generally regarded as the preferred bariatric procedure for adolescents,” the investigators said. “In cases of substantial long-term weight regain, conversion from SG to RYGB may be considered as a revisional strategy.”
BMI trajectory
Over time, BMI significantly decreased (p<0.001), with a maximal reduction at 1‒3 years and sustained improvement afterwards. Males showed greater BMI decline than females (p<0.001).
Similar BMI trajectories were observed across SEP and ethnic groups, while adolescents with higher BMI at baseline maintained this state throughout follow-up (p<0.001). Furthermore, BS resulted in significant improvements in blood pressure and multiple metabolic parameters, with durable long-term benefits and some sex-specific differences.
“Adolescents from low- and medium-SEP backgrounds made up the majority of BS recipients in our cohort,” the investigators said. “This aligns with national data showing a higher prevalence of severe obesity among lower SEP adolescents, likely reflecting environmental and behavioural determinants.” [Pediatr Obes 2020;15:e12681]
Sex differences
More female patients underwent BS in this study, consistent with international data and a previous study of pharmacotherapy for obesity in adolescents. Compared with males, female patients presented with lower preoperative BMI and lower prevalence of obesity-related comorbidities. [Surg Obes Relat Dis 2025;21:638-647; Int J Obes (Lond) 2025;49:1390-1399; Obesity (Silver Spring) 2020;28:2397-2404]
“These sex differences may reflect earlier referral driven by heightened weight-related stigma, social pressures, and potential clinician bias toward intervention at lower BMI thresholds in females,” the investigators said. [Pediatr Clin N Am 2024;71:819-830]
Study details
Electronic health records of adolescents aged 12–20 years who underwent BS between 2010 and 2024 were used in the current study.
The investigators extracted demographic characteristics, SEP, blood pressure, laboratory parameters, and anthropometry. Using mixed effects models adjusted for sex, ethnicity, SEP, age at BS, and baseline BMI, they analysed longitudinal changes in BMI and cardiometabolic outcomes over a median follow-up of 5.8 years.
“BS in adolescents is typically offered within structured, multidisciplinary obesity programs conducted in specialized centres to optimize clinical outcomes and minimize potential adverse effects,” the investigators said.
“Adolescence represents a critical developmental stage encompassing physical growth, pubertal progression, cognitive maturation, and psychosocial identity formation,” they added.