However, it's crucial to consider the method chosen for weight loss. Recent research has shed light on the negative impact of a popular weight loss procedure, the gastric sleeve (or sleeve gastrectomy), on the bone health of adolescents and young adults. Despite significant reductions in patients' Body Mass Index (BMI) two years post-procedure, the study noted a decrease in bone density, strength, and marrow fat.
What do we know about weight loss through surgery?
A study published in the Radiology journal of the Radiological Society of North America (RSNA) points out the adverse effects of a common weight loss surgery on the bones of obese adolescents and young adults.
The study was led by Miriam A. Bredella, a highly respected figure in the field, serving as a professor of radiology at Harvard Medical School in Boston, Massachusetts, and vice president for faculty affairs and clinical operations. Bredella elaborated, as reported by SciTechDaily, that while weight loss surgery is the most effective method to reduce weight and improve cardiometabolic comorbidities, it has long-term effects on bone strength and bone marrow fat, especially in adolescents and young adults.
Understanding the Gastric Sleeve Procedure
The gastric sleeve procedure, which involves the removal of about 75-80% of the stomach to limit food intake and stimulate weight loss, has seen a significant rise in popularity. Data from the American Society for Metabolic and Bariatric Surgery shows that the number of gastric sleeve procedures performed annually in America surged from over 28,000 in 2011 to over 122,000 in 2020, surpassing gastric bypass as the primary operation for weight loss.
The study enrolled participants aged between 13 and 24 years from 2015 to 2020 who had moderate to severe obesity. The younger adults had a maximum BMI of 35 or higher, indicating obesity, while the adolescent participants were at 120% of the 95th percentile specific to their age and sex.
Observations
The study consisted of 54 participants, 25 of whom underwent gastric sleeve surgery, and 29 who were in the control group. The majority of these participants were females. The surgical group was comprised of participants with a BMI of 40 or more, or those with at least one obesity-related comorbidity. The control group, while obese, did not undergo gastric sleeve surgery but were given dietary advice and exercise plans.
To assess the impact of the surgery on bone health, physical exams, blood tests, and computed tomography of the lumbar spine were performed both before and 24 months following the surgery. These measures aimed to quantify volumetric bone mineral density and estimate bone strength using finite element analysis. This analysis method is highly accurate in detecting changes in bone mineral density following significant weight loss.
As bone marrow fat has been found to react to nutritional changes and can serve as a bone quality indicator, proton MR spectroscopy was used to measure bone marrow fat in the lumbar spine. Two years post-surgery, the BMI of the adolescents and young adults in the surgical group had significantly decreased by an average of 11.9, while a slight increase of 1.5 was noted in the control group. Compared to the control group, those who had undergone gastric sleeve surgery showed a notable increase in bone marrow fat and a decrease in lumbar spine bone density and strength estimates.
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