- Sleeve gastrectomy, a common weight-loss surgery, may result in loss of bone density in teens and young adults.
- However, experts say it’s still unknown if this can eventually lead to increased health risks later in life.
- Health experts also say that the benefits of weight-loss surgery may outweigh the potential risks for teens and young adults living with obesity.
The most common type of weight-loss surgery in adolescents and young adults has been associated with bone density loss.
That’s according to a new study published in Radiology, a journal of the Radiological Society of North America (RSNA).
The study included 54 total participants between the ages of 13 and 24 who fit the criteria for obesity. Twenty-five (25) participants underwent sleeve gastrectomy and the remaining 29 were in the control group.
The sleeve surgery group included participants with at least one obesity-related comorbidity, or health condition such as diabetes, or a body mass index (BMI) of 40 or more.
The control group was living with obesity, did not plan to undergo sleeve gastrectomy, and received dietary and exercise counseling.
Bone strength was measured just before surgical interventions and once again 24 months after the sleeve surgery.
The sleeve surgery group experienced a significant drop in total BMI (-11.9, on average) whereas the control group saw a slight rise in BMI (+1.5, on average).
Importantly, the sleeve gastrectomy participants had a significant increase in bone marrow fat and a decrease in bone density and strength estimates in the lumbar (lower) spine.
“We found that bone strength was lower two years after weight-loss surgery, while bone marrow fat, a marker of bone weakening, was increased, suggesting that weight-loss surgery has negative effects on bone health,” says the study’s lead investigator, Miriam A. Bredella, MD, professor of radiology at Harvard Medical School in Boston, Massachusetts, and vice chair for Faculty Affairs and Clinical Operations, Department of Radiology Massachusetts General Hospital in Boston in a press release.
Bredella explains adolescence is a critical time for building up bone mass, and deficits in bone accrual during these years could have a long-term impact on bone health and fracture risk in this younger population later in life.
Bredella adds that the study opens the conversation for how to best support bone health with nutritional supplementation in cases where sleeve surgery is necessary.
Experts weigh in on the limitations of the study
The study results are interesting, but experts also say the ability to apply the findings to a general population is limited due to the study’s design.
Dr. Mir Ali, MD, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA tells Healthline the study is small and only looks at one aspect of weight-loss surgery.
“The limitation of the study is that weight-loss surgery patients were compared to patients that did not lose weight,” says Ali. “If a comparison was made to adolescents who lost weight by other means than surgery, it would be a more effective study.”
Dr. Ernst von Schwarz, MD, PhD, FESC, FACC, FSCAI, a cardiologist, professor of medicine at UCLA and Cedars-Sinai Medical Center, and author of The Secrets of Immortality, says it’s an interesting yet small study with limitations that may still offer some insight into the development of reduced bone strength or even the development of bone diseases such as osteoporosis later in life.
However, he points out that the long-term effects of the study’s findings aren’t clear.
Even though this surgery may lead to a reduction in bone density for some patients, von Schwarz says it’s not known if this will eventually lead to longer-term health risks too.
Additionally, von Schwarz tells Healthline that the potential differences in exercise or physical activities between study groups needs to be considered as a reason for higher bone density.
What parents need to know about weight-loss surgery risks versus benefits
Ali says the benefits of weight loss far outweigh the risks of surgery at this point.
“In general, obesity is a major risk factor not only for the development of cardiovascular disease and heart failure but also for frailty, immobility, degenerative joint and muscle diseases over time,” says von Schwarz.
“The enormous benefits of weight loss are indisputable for overall health and beneficial long-term outcomes,” he says. “Risk and benefits of any surgery need to be considered before making a decision, but the long-term issues with obesity are likely worse, and the benefits of weight loss following bariatric surgery outweighs possible risks of bariatric surgery in the long run,” von Schwarz tells Healthline.
“Weight-loss surgery for adolescents is recommended if they have a BMI greater than 40, or greater than 35 with other comorbid conditions such as diabetes, hypertension or sleep apnea,” adds Ali. “This criteria is the same for sleeve gastrectomy and gastric bypass and the choice of the surgery depends on the patient and other conditions.”
Looking beyond the BMI to find what’s right for your family
The body mass index is an estimate of total body fat based on a person’s height and weight.
It has limitations but is used widely in clinical settings. However, the BMI number isn’t the sole factor to consider in weight-loss surgery, say experts.
“The patient and their parents should undergo thorough education about weight-loss surgery, including risks and benefits,” says Ali. “They have to have a stable home environment and a supportive parent or guardian.”
Ali tells Healthline that while the level of risk is very low, it’s not zero.
“The patient and family need to make an informed decision if the procedure is suitable for their situation,” Ali says.
Ali provides some insight for families to consider:
- Weight-loss surgery should not be performed until the patient has reached skeletal maturity as deemed by their pediatrician.
- Loss of bone strength can have an effect, but proper nutrition and nutritional supplements should be able to prevent long-term problems.
- 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.
Non-surgical tips for healthy adolescent weight loss
There are many routes to weight loss, and finding what works long-term can include a combination of strategies.
Haley Perlus has a PhD in sport and exercise psychology and a master of science in coaching behavior. She also has certifications in sports and nutrition and fitness coaching.
Perlus tells Healthline about some healthy ways of losing weight in adolescence and how parents can help support their children.
Practice portion control
“Parents can help by offering appropriate serving sizes that meet their child’s nutritional needs without overfeeding,” says Perlus. “It’s important to pay attention to the cues of hunger and fullness that children express,” she adds.
“Parents can support their children in maintaining a healthy weight and overall well-being by providing balanced meals and snacks in reasonable portions,” says Perlus.
Include physical activities throughout the day
“Find physical activities your adolescent enjoys and make them a regular part of their routine,” she says. “This could include dancing, riding a bike, or participating in sports.”
Be mindful of snacking
“If your child is hungry in between meals, opt for nutritious snacks such as fresh fruits, vegetables with hummus or yogurt dip, nuts, seeds, or whole-grain crackers,” Perlus says.
“Avoid mindless snacking while watching TV or using electronic devices,” she adds.
Weight-Loss Surgery May Weaken Bones of Teens and Young Adults
Source: Pinoy Lang Sakalam
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