A new study published in JAMA Network Open suggests that metabolic and bariatric surgery offers good long-term value for adolescents living with severe obesity. Researchers found that both sleeve gastrectomy and Roux-en-Y gastric bypass were cost-effective compared with no surgery, with sleeve gastrectomy emerging as the preferred strategy over a 10-year period.
For many teenagers living with severe obesity, losing weight isn’t simply a matter of eating less or exercising more. Obesity is a complex, chronic disease that can increase the risk of serious health conditions, including type 2 diabetes, high blood pressure, sleep apnoea and fatty liver disease. It can also affect confidence, mental wellbeing and overall quality of life.
While healthy eating, physical activity and behavioural support remain the first steps in treatment, they don’t always lead to lasting weight loss for every young person with severe obesity. In these cases, metabolic and bariatric surgery may be considered as part of specialist care.
The study explored an important question: Can bariatric surgery provide good long-term value as a treatment for adolescents with severe obesity?
To answer this, researchers analysed data from the internationally recognised Teen-LABS study and modelled the outcomes of 100,000 adolescents with severe obesity over a 10-year period. They compared three treatment approaches:
- No bariatric surgery
- Sleeve gastrectomy
- Roux-en-Y gastric bypass (gastric bypass)
Rather than looking only at weight loss, the researchers also assessed overall health, quality of life and the long-term value of each treatment.
What Did the Study Find?
The findings were encouraging.
The researchers found that both sleeve gastrectomy and Roux-en-Y gastric bypass offered better long-term value than no surgery for adolescents with severe obesity over a 10-year period. Sleeve gastrectomy emerged as the most cost-effective option, with an incremental cost-effectiveness ratio (ICER) of $41,164 per quality-adjusted life year (QALY) gained, compared with $50,271 per QALY gained for gastric bypass when each procedure was compared with no surgery.
The study also projected important health benefits following surgery:
- Average BMI decreased by 19.2% after sleeve gastrectomy and 20.6% after gastric bypass over 10 years.
- Type 2 diabetes went into remission in 41% of patients after sleeve gastrectomy and 58% after gastric bypass.
- Sleeve gastrectomy remained the preferred cost-effective strategy across multiple sensitivity analyses, while gastric bypass produced slightly greater overall health gains but at a considerably higher cost.
In healthcare, “cost-effective” doesn’t mean a treatment is inexpensive. It means researchers compared the cost of treatment with the long-term health benefits it provides, including improvements in quality of life, better management of obesity-related health conditions and the potential to reduce future healthcare costs.
Based on these findings, the authors concluded that metabolic and bariatric surgery is a worthwhile long-term treatment option for appropriately selected adolescents with severe obesity and that the evidence could help guide future clinical practice and healthcare policy.
Why This Research Matters
Previous research has already shown that bariatric surgery can help adolescents with severe obesity achieve significant and sustained weight loss while improving obesity-related health conditions. This latest study looked beyond those clinical outcomes to answer another important question: does bariatric surgery also represent good long-term value?
The projected improvements in BMI and the high rates of type 2 diabetes remission demonstrate that bariatric surgery has the potential to deliver meaningful health benefits alongside long-term value. These findings may help clinicians, researchers, and healthcare policymakers make informed decisions about improving access to bariatric surgery for adolescents living with severe obesity.
Bariatric Surgery Is About More Than Weight Loss
Although weight loss is often the most noticeable result, bariatric surgery is designed to improve overall metabolic health.
For many people, the benefits extend beyond the number on the scales. Bariatric surgery may help improve obesity-related conditions such as type 2 diabetes, high blood pressure and sleep apnoea, while also reducing the risk of future health complications and improving quality of life.
This reflects a growing understanding that obesity is a chronic disease requiring comprehensive, evidence-based treatment rather than simply focusing on weight loss alone.
What These Findings Mean for Patients
This study provides further evidence that metabolic and bariatric surgery can offer meaningful long-term value for appropriately selected adolescents with severe obesity. However, it’s important to remember that this was an economic evaluation based on a simulation model using data from the Teen-LABS study rather than a clinical trial. The findings should therefore be considered alongside the wider body of evidence on bariatric surgery.
What the research does show is that both sleeve gastrectomy and Roux-en-Y gastric bypass offered better long-term value than no surgery over a 10-year period. Sleeve gastrectomy emerged as the most cost-effective option, while gastric bypass produced slightly greater overall health gains but at a higher cost.
For families and healthcare professionals caring for adolescents with severe obesity, these findings provide further support for considering metabolic and bariatric surgery as a treatment option for appropriately selected patients. As research continues to evolve, studies like this will help guide future clinical practice and healthcare policy while improving access to evidence-based obesity care.
Considering Bariatric Surgery?
At Phoenix Health, we believe that every patient’s journey is unique. Our multidisciplinary team provides personalised assessments, expert surgical care and long-term follow-up to help patients make informed decisions about bariatric surgery. If you’d like to learn more about your bariatric treatment options, we’re here to help
Reference:
Rode, J. B., et al. (2026) A 10-Year Cost-Effectiveness Analysis of Metabolic and Bariatric Surgery in Adolescents. JAMA Netw Open. DOI: 10.1001/ja manetworkopen.2026.18648. https://jamanetwork.com/journals/jamanet workopen/fullarticle/2850246
Ryder, J. R., et al. (2024). Ten-Year Outcomes after Bariatric Surgery in Adolescents. N Engl J Med. 391(17):1656–1658. DOI: 10.1056/NEJMc2404054. https://www.nejm.org/doi/full/10.1056/NEJMc2404054
Medically Reviewed by Lujain Alhassan, BSc, ANutr
Registered Associate Nutritionist and Bariatric Nutrition
