Severe obesity in adolescence profoundly impacts health and social wellbeing. Lifestyle modifications are seldom successful in maintaining sufficient weight loss to mitigate the risk of complications. Metabolic and Bariatric surgery (MBS) is a standard treatment for adult patients and has emerged as an option for adolescent patients. Several high-quality studies of adolescent MBS show substantial and sustained improvements both in weight and cardiometabolic parameters, as well as a safety profile similar to that seen in adult patients. Patients report improvements in health- and weight-related quality of life. Concerns around adolescent MBS can be attributed to a fear of side-effects on growth and puberty, risk of nutritional deficiencies and osteoporosis, alcohol abuse, psychosocial vulnerability, and the ability to consent in the decision process. Guidelines give somewhat different recommendations, but the most comprehensive guidelines from the American Society for Metabolic and Bariatric Surgery recommend MBS for class III obesity or class II obesity with comorbidity. This mini-review aims to present published data on MBS in adolescents. We discuss indications for MBS and the optimal timing in the young person´s life, the choice of surgical method, and MBS in relation to the new anti-obesity medications. Based on data primarily from the USA and Sweden, we conclude that MBS is a valuable treatment option for adolescents with severe obesity that appears under-utilized against the backdrop of the poor prognosis of severe obesity. We argue for continued research, development of guidelines, multi-professional teamwork, long-term follow-up, and centralization of adolescent MBS.


中文翻译：

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青少年的代谢和减肥手术——为谁、何时以及如何进行？

青春期的严重肥胖严重影响健康和社会福祉。生活方式的改变很少能成功地保持足够的体重减轻以降低并发症的风险。代谢和减肥手术 (MBS) 是成人患者的标准治疗方法，并已成为青少年患者的一种选择。几项关于青少年 MBS 的高质量研究显示，体重和心脏代谢参数均得到显着和持续的改善，并且安全性与成年患者相似。患者报告健康和体重相关的生活质量有所改善。对青少年 MBS 的担忧可归因于对生长和青春期副作用的恐惧、营养缺乏和骨质疏松症的风险、酗酒、社会心理脆弱性、以及在决策过程中同意的能力。指南给出了一些不同的建议，但美国代谢和减肥外科学会最全面的指南推荐 MBS 用于 III 级肥胖或 II 级肥胖合并症。这篇小型综述旨在展示已发表的关于青少年 MBS 的数据。我们讨论了 MBS 的适应症和年轻人生活中的最佳时机、手术方法的选择以及与新的抗肥胖药物相关的 MBS。根据主要来自美国和瑞典的数据，我们得出结论，MBS 是严重肥胖青少年的一种有价值的治疗选择，在严重肥胖预后不良的背景下似乎未得到充分利用。我们主张继续研究、制定指南、多专业团队合作、长期跟进，