title: Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis.
abstract: Little is known about the long-term outcomes of bariatric surgery for severe adolescent obesity, raising questions about the durability of early responses to surgery. We aimed to analyse long-term (>5 years) outcomes of Roux-en-Y gastric bypass in a cohort of young adults who had undergone the operation during adolescence, in the Follow-up of Adolescent Bariatric Surgery at 5 Plus Years (FABS-5+) extension study.
  
  
  
  A cohort of young people aged 13-21 years underwent Roux-en-Y gastric bypass for clinically severe obesity at a paediatric academic medical centre in the USA. We did a prospective follow-up analysis of these patients' outcomes 5-12 years after surgery. Outcomes assessed included BMI, comorbidities, micronutrient status, safety, and other risks. The FABS study is registered with ClinicalTrials.gov, number NCT00776776.
  
  
  
  Between May, 2001, and February, 2007, 74 young people underwent Roux-en-Y gastric bypass in the FABS study. Of these, 58 individuals were eligible for the FABS-5+ study, could be located, and agreed to follow-up assessment. At baseline, the mean age of the cohort was 17·1 years (SD 1·7) and mean BMI was 58·5 kg/m2(10·5). At mean follow-up of 8·0 years (SD 1·6; range 5·4-12·5), the mean age of the cohort was 25·1 years (2·4) and mean BMI was 41·7 kg/m2(12·0; mean change in BMI -29·2% [13·7]). From baseline to long-term follow-up, significant declines were recorded in the prevalence of elevated blood pressure (27/57 [47%] vs 9/55 [16%]; p=0·001), dyslipidaemia (48/56 [86%] vs 21/55 [38%]; p<0·0001), and type 2 diabetes (9/56 [16%] vs 1/55 [2%]; p=0·03). At follow-up, 25 (46%) of 58 patients had mild anaemia (ie, not requiring intervention), 22 (45%) had hyperparathyroidism, and eight (16%) had low amounts of vitamin B12 (ie, below the normal cutpoint).
  
  
  
  Roux-en-Y gastric bypass surgery resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults. Long-term health maintenance after Roux-en-Y gastric bypass should focus on adherence to dietary supplements and screening and management of micronutrient deficiencies.
  
  
  
  Ethicon Endosurgery, National Center for Advancing Translational Sciences (US National Institutes of Health).
authors.affiliation: Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: thomas.inge@childrenscolorado.org.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Inge
authors.affiliation: Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Jenkins
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Stavra A
authors.initials: SA
authors.lastname: Xanthakos
authors.affiliation: Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado, Denver, CO, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.affiliation: Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Meg H
authors.initials: MH
authors.lastname: Zeller
authors.affiliation: Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Helmrath
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002319:Cardiovascular System / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult