First Adolescent Bariatric Center of Excellence: Guidelines, Procedures, Pitfalls and Solutions

Ragui W Sadek, MD, FACS1, Andrew M Wassef, BA2. 1Robert Wood Johnson University Hospital, 2Rutgers Robert Wood Johnson Medical School

Background: Adolescent obesity, a seemingly nonexistent occurrence to children of the 1960’s, has developed into one of the most chronic diseases plaguing children today. Comorbidities commonly associated with adult morbid obesity, such as type II diabetes mellitus, hypertension, and dyslipidemia, are now diseases associated with a much younger subset of morbidly obese patients (15-21 YOA). With the astronomical quadrupled growth of adolescent obesity in just 30 years time, consideration for more invasive treatments such as surgical management of adolescent obesity, has been tested, tried, and found wanting. We present the case of the first established Adolescent Bariatric Center of Excellence in the United States. The following review discusses the epidemiology of adolescent obesity, markers for operative therapy, optimal surgical procedures for adolescent weight loss, multidisciplinary management for this unique patient population, and surprising outcomes of our program.

Methods: The following study consists of forty-one (n=41) adolescent bariatric patients (Male=26, Female=15) with ages ranging from 15-21 years of age who received sleeve gastrectomy. All patients received weight check and blood workup and general examination pre-operatively and post operatively at 1 week, 1 month, 3 month, 6 months and 1 year. All patients were enrolled in the Adolescent Bariatric Center of Excellence at Bristol Meyer Squibb Children’s Hospital and subject to all requirements including nutrition, exercise, and support group regimens. Patients were accessed for excess weight loss, resolution of comorbidities, complications, vitamin deficiencies, and general quality of life.


  Male Female
Excess Weight Loss 83% 80%
Resolution of T2DM 100% 95%
Resolution of Hyperlipidimia 100% None
Resolution of Joint Pain 100% 100%
Complication Rate 0% 0%
Vitamin Deficiency 0% 0%

Quality of Life Increase After Surgery

(1-10 before/1-10 after)-100

60.5% 58.5%

Conclusions: Surgery for obesity in adolescents has particular risks and benefits that must be accounted for when considering an invasive approach due to their unique physiological, psychological and emotional needs. As such, reasonable guidelines are necessary to ensure successful/safe weight loss in adolescent patients.

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