Adolescents who undergo bariatric surgery experience more durable health benefits than their adult counterparts, according to groundbreaking research published in the New England Journal of Medicine. The decade-long study followed 260 teenagers who received weight-loss surgery, documenting substantial and sustained improvements in both weight management and obesity-related comorbidities.
After 10 years of follow-up, participants maintained an average 20% reduction in body mass index (BMI), with more than half experiencing significant weight loss. More impressive were the improvements in cardiovascular health markers, including a 57% reduction in high blood pressure and a 54% decrease in elevated cholesterol levels.
"Our study presents impressive outcomes of the longest follow-up of weight-loss surgery during adolescence, which validates bariatric surgery as a safe and effective long-term obesity management strategy," said lead investigator Justin Ryder, vice chair of research for the Department of Surgery at Ann & Robert H. Lurie Children's Hospital of Chicago.
The most striking finding was the diabetes remission rate. Approximately 55% of adolescents who had type 2 diabetes before surgery remained in remission a decade later. This far exceeds the 12-18% remission rates typically observed in adults who undergo similar procedures.
"This is considerably better than the outcomes reported in people who underwent bariatric surgery as adults, a major reason why treating obesity seriously in adolescents is so important," Ryder noted.
Dr. Thomas Inge, surgeon-in-chief at Lurie Children's and senior researcher on the study, explained: "The fascinating part is that when we use these operations in teenagers, the remission of health conditions like diabetes and high blood pressure are more durable than when operations are done later in adulthood."
Patient Perspective
Hillary Fisher, now 31, was one of the study participants who underwent bariatric surgery at age 16. "I was crushed by the daily issues I faced due to my weight, health problems and bullying in high school," Fisher said. "After many unsuccessful attempts to lose weight, at 260 pounds, we decided bariatric surgery was the answer."
Fisher lost 100 pounds following the procedure and credits the surgery with transforming her life. "It changed my life. The improved health and self-esteem that came with the 100-pound weight loss were important to me and I would certainly do it again," she stated.
Surgical Approaches Show Similar Efficacy
The researchers found that both major types of weight-loss surgery—gastric bypass and sleeve gastrectomy—produced comparable long-term results. This information provides valuable guidance for surgical decision-making in adolescent patients.
Underutilization of Bariatric Surgery in Adolescents
Despite the compelling evidence supporting early intervention, bariatric surgery remains severely underutilized in the adolescent population. The researchers note that nearly 5 million teenagers in the United States meet eligibility criteria for weight-loss surgery, yet only 1 in every 2,500 adolescents with severe obesity actually receives the procedure.
Broader Context of Pediatric Obesity Treatment
These findings align with other recent research on pediatric obesity interventions. A separate study published in JAMA Pediatrics in January 2025 analyzed data from over 6,700 Swedish children who received obesity treatment before age 18. Children who responded well to treatment or achieved obesity remission showed a 58% lower risk of type 2 diabetes, 69% lower risk of high cholesterol, and 88% lower risk of early death compared to those who did not lose weight.
Emilia Hagman, a researcher at Karolinska Institute who led the Swedish study, emphasized: "Whether or not the treatment of obesity in childhood has long-term health benefits have been debated, since weight-loss is hard to maintain. This emphasizes the importance of providing early treatment, as we know that timely intervention increases the likelihood of success and helps mitigate the long-term health risks associated with obesity."
Implications for Clinical Practice
The superior outcomes observed in adolescents compared to adults may be explained by the natural progression of metabolic diseases. Type 2 diabetes tends to advance more rapidly in younger individuals, making early intervention particularly beneficial.
These studies collectively strengthen the case for more aggressive and earlier treatment of severe obesity in adolescents, potentially including greater consideration of surgical options and newer pharmacological approaches when appropriate.
As the evidence for long-term benefits continues to mount, healthcare providers and policymakers may need to reconsider current treatment guidelines and insurance coverage policies to ensure that adolescents with severe obesity have access to the full range of effective interventions.
