Metabolic outcomes of bariatric surgery versus lifestyle intervention in adolescents with severe obesity: A systematic review and meta-analysis.

Data from clinical trials evaluating the effectiveness and safety of metabolic and bariatric surgery (MBS) compared to lifestyle modifications (LSM) in children and adolescents with obesity are scarce. This systematic review and meta-analysis (SRM) sought to fill this knowledge gap. Randomised or non-randomised trials spanning at least one-year involving children and adolescents with severe obesity receiving any form of MBS in the intervention group and LSM for weight loss in the control group were systematically searched through electronic databases. This SRM adhered to the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA checklists. The primary outcome of interest was the change in body weight from the baseline. Five trials (three randomised, open-label and two non-randomised) with 1-2 years follow-up durations were analysed, including 367 participants aged 10-19 years. MBS resulted in greater reductions in body weight (mean difference [MD] -25.83 kg, 95% confidence interval [CI] [-36.91, -14.75], p < .00001) and per cent body weight (MD -24.54%, 95% CI [-33.19, -15.89], p < .00001) compared to LSM. Furthermore, MBS outperformed LSM in reducing body mass index (BMI), BMI z-score, waist circumference, glycated haemoglobin, fasting plasma glucose, insulin resistance, triglycerides, alanine aminotransferase, high sensitivity C-reactive protein and an overall improvement of physical functioning and quality of life. The safety profile was comparable between the two groups; however, data was scarce. Larger, longer-term trials that include multinational and multiethnic representation are essential for making solid clinical practice recommendations regarding MBS for children with obesity.