Background

Long-term variation in weight loss maintenance following metabolic and bariatric surgery (MBS) among adolescents with ≥ Class 2 obesity has been understudied. Our objective was to identify unique 10-year BMI trajectories following Roux-en-Y Gastric Bypass (RYGB) and Vertical Sleeve Gastrectomy (VSG) in adolescents and evaluate whether early (baseline, 6-month) clinical and/or behavioral characteristics were predictive of trajectory group membership. Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective observational study at five US centers, enrolled consecutive patients ≤19 years following MBS, of which 161 and 99 underwent RYGB and VSG, respectively. Latent class growth modeling was used to construct %BMI change trajectories 10 years following MBS. The relationship between early-stage predictors and trajectory group membership was evaluated using cumulative logit modeling. Ten years after MBS, mean %BMI change from baseline was -20% (95% CI: -22, -18). Latent class analysis identified four unique BMI change trajectories (mean posterior probability of group membership, 0.93). Ten-year %BMI change by trajectory group was: Group 1, -43% (ideal weight loss maintenance); Group 2, -23%; Group 3, -12%; Group 4, +8% (high weight regain). Adjusted cumulative logit modeling found that %BMI change at 6 months was significantly associated with trajectory group membership (p<0.01). Greater 6 month %BMI loss was associated with a more successful 10-year BMI trajectory (Odds Ratio: 1.16 [1.11, 1.21]). Ten years following MBS, four distinct BMI change trajectories were identified among adolescents who underwent RYGB or VSG. Greater 6 month postoperative BMI loss was associated with more favorable 10-year trajectories.