P2D328: Association Between Age of Onset of Severe Obesity, Race/ethnicity, and Weight Reduction After Sleeve Gastrectomy in Adolescents and Young Adults

Background: Preliminary data from our group suggests that earlier onset of obesity may be associated with suboptimal weight reduction outcomes after laparoscopic sleeve gastrectomy (LSG) in adolescents and young adults. There is some evidence in the literature that non-Hispanic black (NHB) and Hispanic adolescents have poorer outcomes after bariatric surgery than non-Hispanic white (NHW) adolescents. We hypothesize that NHB and Hispanic patients with a history of severe obesity before 18 years old have particularly limited long-term weight reduction outcomes after LSG.

Methods: We retrospectively reviewed records of all patients who underwent LSG at age 25 years or younger at our institution between 2013 and 2020. All weight data documented in the medical record through February 2023 was included. We calculated weight change postoperatively as percent total body weight reduction (%TBWR) relative to preoperative weight. Self-reported racial/ethnic groups included NHB, NHW, and Hispanic. Patients with available historical BMI data were grouped into those with (1) early onset of severe obesity (BMI > 40 or BMI > 140% of the 95th percentile before age 18) or (2) later onset of severe obesity (BMI < 40 until after age 18).

Results: Of 141 patients aged 25 years or younger who underwent LSG, 79 patients had available weight data from before age 18. In NHW patients, mean %TBWR at nadir was 32.9±8.1% in the early-onset group compared to 31.2±4.4% in the late-onset group (p = 0.68), and mean longitudinal %TBWR was 11.6±8.9% in the early-onset group compared to 19.2±8.5% in the late-onset group (p = 0.17). In NHB patients, mean %TBWR at nadir was 19.1±9.5% in the early-onset group compared to 32.5±5.1% in the late-onset group (p < 0.01), and mean longitudinal %TBWR was 6.0±12.4% in the early-onset group compared to 20.0±10.6% in the late-onset group (p = 0.06). In Hispanic patients, mean %TBWR at nadir was 26.7±12.1% in the early-onset group compared to 31.3±5.9% in the late-onset group (p = 0.40), and mean longitudinal %TBWR was 9.4±11.4% in the early-onset group compared to 13.0±10.3% in the late-onset group (p = 0.60).

Conclusion: Among adolescents and young adults who underwent LSG at our institution, NHB patients with severe obesity before age 18 had significantly less %TBWR at postoperative weight nadir than NHB patients who developed severe obesity after age 18. There was no significant association between age of onset of obesity and %TBWR at nadir in Hispanic or NHW patients. In all racial/ethnic groups there was a trend towards less long-term %TBWR in those with severe obesity before age 18, most pronounced in NHB patients. Our findings suggest that NHB patients who develop severe obesity early in life may be at particularly high risk for suboptimal weight reduction outcomes after LSG.