2.4.3.0 Metabol­ic Surgery

Rec­om­men­da­tions

13.67 Metabol­ic surgery may be con­sid­ered for the treat­ment of ado­les­cents with type 2 di­a­betes who are marked­ly obese (BMI >35 kg/m2) and who have uncon­trolled glycemia and/‍or se­ri­ous co­mor­bidities de­spite lifestyle and phar­ma­co­log­ic in­ter­ven­tion. A

13.68 Metabol­ic surgery should be per­formed only by an ex­pe­ri­enced sur­geon work­ing as part of a well-‍or­ga­nized and en­gaged mul­ti­dis­ci­plinary team in­clud­ing sur­geon, en­docri­nol­o­gist, nu­tri­tionist, be­hav­ioral health spe­cial­ist, and nurse. A

The re­sults of weight-‍loss and lifestyle in­ter­ven­tions for obe­si­ty in chil­dren and ado­les­cents have been dis­ap­point­ing, and no ef­fec­tive and safe phar­ma­co­log­ic in­ter­ven­tion is avail­able or ap­proved by the U.S. Food and Drug Ad­min­is­tra­tion in youth. Over the last decade, weight-‍loss surgery has been in­creas­ingly per­formed in ado­les­cents with obe­si­ty. Small ret­ro­spec­tive anal­y­ses and a re­cent prospec­tive mul­ti­cen­ter nonran­dom­ized study sug­gest that bariatric or metabol­ic surgery may have beneļ¬ts in obese ado­les­cents with type 2 di­a­betes sim­i­lar to those ob­served in adults. Teenagers ex­pe­ri­ence sim­i­lar de­grees of weight loss, di­a­betes re­mis­sion, and im­provement of cardiometabol­ic risk fac­tors for at least 3 years after surgery (149). No ran­dom­ized tri­als, how­ev­er, have yet com­pared the ef­fec­tiveness and safe­ty of surgery to those of con­ven­tion­al treat­ment op­tions in ado­les­cents (150). The guide­lines used as an in­di­ca­tion for metabol­ic surgery in ado­les­cents gen­er­ally in­clude BMI >35 kg/m2 with co­mor­bidities or BMI >40 kg/m2 with or with­out co­mor­bidities (151-162). A num­ber of groups, in­clud­ing the Pe­di­atric Bariatric Study Group and the Teen Lon­gi­tu­di­nal As­sessment of Bariatric Surgery (Teen-‍LABS) Study have demon­strat­ed the ef­fec­tiveness of metabol­ic surgery in ado­les­cents (155-161).