Pediatricians are often reluctant to recommend bariatric surgery for teen-agers, but a Rutgers-led study concludes it is a justifiable treatment for adolescents with persistent extreme obesity if they can maintain a healthy lifestyle afterward.

The researchers reviewed studies on bariatric surgery in adolescents and adults in their report in The Journal of Pediatrics.

"If we look at obesity as a disease with the real possibility of eventual organ system failure and special health concerns for adolescents, we need to ask whether health care practitioners are doing enough to manage it," said lead author Ahmed Khattab, a physician at Rutgers Robert Wood Johnson Medical School's Division of Pediatric Endocrinology. "The objective evidence shows that, under the right circumstances and with the right patients, bariatric surgery is an effective treatment for adolescents with obesity."

The findings are consistent with those of a separate study, published May 16 in the New England Journal of Medicine.

Obesity and its related conditions, including hypertension, cardiovascular disease and type 2 diabetes, are increasing worldwide in adults and children, according to the study. Excess weight and obesity in adolescents cost more than $14 billion per year. Meanwhile, type 2 diabetes causes more severe insulin deficiency and other complications in youths than in adults and the steps being taken to avoid obesity or prevent its complications are often ineffective.

Although bariatric surgery requires lifelong follow-up and monitoring of nutritional deficiencies, it is considered effective for severe obesity in adults, leading to long-term improvement or remission in obesity-related diabetes and other disorders, sustained weight loss and an improved quality of life.

Studies of bariatric surgery in adolescents, although scarce, show it is associated with remission of type 2 diabetes, abnormal kidney function and other complications of obesity, and that resulting nutritional deficiencies can be corrected with dietary supplements.

When considering bariatric surgery for teenagers, the researchers recommend pediatricians follow the guidelines published by the Endocrine Society. They recommend the procedure only for patients who have neared the end of puberty and are close to their final adult height; who have extreme obesity and related complications that persist despite the patient's compliance with a formal program of lifestyle modification; and who demonstrate the ability to follow a regimen of healthy eating and living habits.

The researchers also follow the Endocrine Society in saying bariatric surgery is not recommended for patients who have not mastered healthy eating and living habits or who have unresolved substance abuse, eating or psychiatric disorders.