Trends in metabolic and bariatric surgery among adolescents, 2016-2025.

BACKGROUND

Guidelines endorse metabolic and bariatric surgery (MBS) for eligible adolescents with severe obesity. We described trends in MBS among eligible adolescents and characterized demographic and clinical features, postoperative healthcare utilization, and complications.

METHODS

Using Epic Cosmos, we conducted a retrospective, population-based study of US adolescents aged 12-19 years from 2016 through 2025. The primary outcome, annual MBS utilization among eligible adolescents, was modeled by negative binomial regression. Secondary outcomes (patient characteristics, healthcare utilization, complications) were assessed with t-tests, chi-square, weighted least-squares, and logistic regression.

RESULTS

Overall, 5430 adolescents underwent MBS, with utilization rising 7.7-fold from 31 to 239 per 100,000 eligible (p < 0.001); at peak, only 0.24% of those eligible underwent MBS. Sleeve gastrectomy (SG) predominated (89.1%). Utilization was steeply graded by obesity severity: by 2025, adolescents with a BMI ≥50 kg/m2 underwent SG roughly nine times as often as those at the lowest eligible BMI class (605 vs 69 per 100,000). Mean length of stay declined from 2.0 to 1.6 days (p < 0.001). Serious early complications were uncommon: within 30 days, surgical and infectious complications each affected ≤0.6% of patients, and cardiovascular and thromboembolic events ≤0.3%. The most common diagnoses were gastrointestinal and biliary: nausea and vomiting (12.5%) by one year and cholecystectomy (7.5%) by three years. Reoperation, conversion to gastric bypass, and death were rare (each <0.4%).

CONCLUSIONS

Despite increasing use, only a small fraction of eligible adolescents undergo MBS. Given low complication rates, these data highlight a need to expand more equitable access and implementation within clinical workflows.