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Researchers are expressing concerns over the bone health of teens who have weight loss surgery. Duet Postscriptum/Stocksy
  • Weight loss surgery is being used more frequently on adolescents, teens, and young adults who have obesity.
  • However, researchers are reporting that these types of procedures may decrease bone density as well as weaken the bones of these young patients.
  • Experts say more research needs to be done to determine if the surgery or the loss of weight is responsible for the decrease in bone strength.

Weight loss surgery for adolescents and teens with obesity who meet certain clinical criteria may impact their bone strength as their young bodies continue to develop, a study published today in the journal Radiology suggests.

Such surgeries, while once controversial, are on the rise, especially after major groups such as the American Academy of Pediatrics (AAP) and American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee began recommending metabolic and bariatric surgery along with lifestyle modification to treat cases of severe obesity.

“Weight loss surgery is not considered lightly for any patient and is used as a last resort after multiple other interventions have been performed,” said Dr. Christina Johns, a pediatric urgent care doctor and a senior medical advisor at PM Pediatric Care who was not involved in the study.

“There are specific criteria that are used when evaluating these patients,” she told Medical News Today.

There are positive effects that weight loss surgery can have for teens and adolescents. These include a reduction in weight and comorbidities such as diabetes.

However, researchers said that other impacts of such procedures on children’s development are understudied and they sought to address those issues in their study.

The researchers studied a group of 54 adolescents, teens, and young adults with obesity between the ages of 13 and 24.

Of the participants, 25 underwent a standard weight loss procedure known as a “sleeve gastrectomy,” which reduces the size of the stomach.

The other 29 young participants were in a control group that did not receive surgery.

The scientists, led by researchers at the Harvard Medical School in Boston, reported significant increases in bone marrow fat — a biomarker for weakened bones — and a decrease in bone density and strength estimates among those who received the surgery.

“The concern is that if this result is reproduced and validated, these patients could be susceptible to increased risk of fracture and other degenerative bone and joint diseases since bone mass typically increases significantly during growth in adolescence,” said Johns.

“As bariatric surgery is increasingly performed in adolescents, its effect on bone health needs to be emphasized, especially to the physicians who will continue to provide routine medical care for these patients,” Dr. Miriam Bredella, a professor of radiology at Harvard Medical School in Boston and vice chair for Faculty Affairs and Clinical Operations in the Department of Radiology Massachusetts General Hospital in Boston, said in a press release.

“We hope that our study will raise awareness on the effects of weight-loss surgery on bones in adolescents with obesity,” she added.

The study is an important step in examining how dramatic medical procedures such as weight loss surgery can affect a developing body, but experts say the results are far from conclusive.

For instance, in the two years following weight loss surgery, the body-mass index (BMI) among those in the surgery group dropped almost 12 points on average, while it increased in the control group by more than 1 point on average.

That poses a problem for determining whether weight loss surgery or simply weight loss is the primary driver of weakened bones, said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.

“The limitations of the study is that weight loss surgery patients were compared to patients that did not lose weight,” Ali, who was not involved in the study, told Medical News Today. “I believe that if a comparison were made to adolescents who lost weight by other means then surgery, it would be a more effective study.”

“Weight loss surgery for adolescents is recommended if they have a BMI greater than 40, or greater than 35 with other co-morbid conditions such as diabetes, hypertension or sleep apnea,” Ali explained. “The benefits of weight loss far outweigh the risks of surgery at this point.”

That said, even if these results do bear out upon further study, experts say there are proactive steps that doctors and patients can take.

“Loss of bone strength can have an effect, but proper nutrition and nutritional supplements should be able to prevent long-term problems,” Ali said. “Bone strength can be improved and recovered with proper nutrition and nutritional supplements such as calcium and vitamin D. Regular exercise is also important in developing healthy bones.”