A Positive Trend in Metabolic Surgery for Teens
These are indeed interesting times for folks who care about the need that so many people have for obesity care. Medicines for obesity, with the advent of GLP-1 agonists, have become much better. Thus the demand for metabolic surgery has slipped a bit. Most metabolic surgeons have seen this in the volume of cases that come to them. But a new publication in the Journal of Pediatrics this week shows a different, positive trend in metabolic surgery for teens.
Specifically, Sarah Messiah and colleagues examined the trend in utilization of metabolic surgery for both adults and teens between 2021 and 2023. This was the period when uptake of semaglutide and tirzepatide was rapid.
An Inflection Point for Adults, but Not Adolescents
The graph above really tells the whole story. The black dotted line plots the trend in surgery utilization for adults and shows a clear and significant inflection point in 2022. From 2022 to 2023, it’s clear that utilization dropped.
But that’s not so for surgery utilization in teens. The growth continued, even though (and perhaps because) utilization of surgery for teens is at a much lower level than it is for adults.
It’s also worth noting that the American Academy of Pediatrics published new guidance on obesity care in youth. It called for offering more care, earlier in life. So really, it should not be a surprise that utilization of one of the most effective tools of obesity treatment – metabolic surgery – would continue to grow after the emergence of this guideline.
Better Equity in Utilization
Another bright spot is the suggestion that racial disparity in access to metabolic surgery may have waned. These data tell us that, for the first time, Black and Hispanic youth have the highest utilization of metabolic surgery compared to all other racial and ethnic groups. Given that they have the greatest need, this is as it should be. But historically, that has not been the case.
Messiah et al describe what may have prompted this progress:
“The observed increase in MBS utilization among adolescents, particularly among historically underserved populations is striking. This shift may be attributed to several factors. First, the publication of the AAP CPGs in 2023, which endorsed MBS as a safe and effective treatment for severe obesity in adolescents, likely played a role in raising awareness and improving access. In addition, systemic barriers, such as limited Medicaid coverage for anti-obesity medications and widespread GLP-1RA supply shortages, may have inadvertently steered patients and providers toward MBS as a more accessible and reliable treatment option.”
This is good progress and we hope it is a signal that we can anticipate better metabolic health ahead for this generation of youth.
Click here for the study and here for perspective on the long-term outcomes of metabolic surgery for adolescents.
Frequency of Metabolic and Bariatric surgery (MBS) Utilization Among Adults (≥20 years) and Adolescents (13-19 years) from 2021 to 2023, data graph by Messiah et al, licensed under CC BY 4.0
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March 29, 2025
