Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018

• This study, published in Annals of Surgery — one of the most respected surgery journals in the world — found that severe obesity among American teenagers was rising sharply from 2015 to 2018, but the number of teens receiving weight loss surgery was not keeping up. This means many teens who could benefit from surgery were not getting access to it.
• The gap between need and access was especially wide for Hispanic and Black teenagers, who are affected by severe obesity at higher rates than other groups but were less likely to receive bariatric surgery during this period. Dr. de la Cruz-Muñoz has advocated for better access to surgical treatment for these underserved communities.
• This research was part of a larger effort by Dr. de la Cruz-Muñoz and his colleagues to track how many teens are getting weight loss surgery across the country. Their work spans nearly a decade of national data (2015–2023) and has been published in peer-reviewed medical journals, adding to the evidence on access to care for teens.
• Findings like these contributed to the evidence base later reflected in the American Academy of Pediatrics' 2023 guidance, which formally recommended that teenagers aged 13 and older with severe obesity be evaluated for bariatric surgery — and called for removing insurance barriers that prevent eligible teens from receiving treatment.
• For families whose teenager is struggling with severe obesity, this research highlights an important message: weight loss surgery is a safe, proven treatment option for teens, and national medical organizations now recommend it for qualifying adolescents. Dr. de la Cruz-Muñoz contributes to both the research and the clinical care of teens considering bariatric surgery.

Why This Study Was Needed

Class II and III obesity (a BMI at least 120% or 140% of the 95th percentile for age and sex) are the fastest-growing forms of obesity in American children. Metabolic and bariatric surgery is safe and effective for these young people, yet anecdotally very few were being referred. No one had measured the actual gap between how many teens qualify and how many receive surgery, or compared their early surgical outcomes directly with adults on a national scale.

How the Study Was Done

The team combined two national data sources. The National Health and Nutrition Examination Survey (NHANES, 19,225 participants) estimated how many US youth have class II/III obesity. The MBSAQIP registry of accredited bariatric centers supplied every recorded operation from 2015 to 2018: 3,846 youth (mean age 17.9) and 744,776 adults. Dividing one by the other produced national utilization rates, and the registry allowed a direct comparison of 30-day complications.

What the Study Found

A large and growing gap

• Class II/III obesity rose from 5.6% to 6.5% of US youth, about 4.8 million young people, while accredited centers recorded fewer than 4,000 operations in patients 19 or younger from 2015 to 2018.
• The utilization rate was 1.81 per 1,000 eligible youth, versus 5.56 per 1,000 eligible adults.
• Hispanic and non-Hispanic Black youth had the highest rates of severe obesity but the lowest use of surgery. In 2018, 45.8% of teens who had surgery were non-Hispanic White, compared with 22.7% Hispanic and 14.2% non-Hispanic Black.

Teens arrive sicker and heavier

• Youth had a higher peak BMI before surgery than adults (48.4 vs 46.5), and nearly a third had a BMI of 50 or more.
• Many already had obesity-related disease: hypertension in 39.8%, sleep apnea in 17.0%, reflux (GERD) in 14.4% and type 2 diabetes in 13.6%.
• Sleeve gastrectomy was the dominant operation (73.3% of youth), followed by gastric bypass (17.0%).

Surgery was as safe in teens as in adults

• 30-day mortality was 0.1% in both groups, and reoperation, bleeding, reintervention and ICU admission rates were statistically similar.
• Readmission was slightly lower in youth (3.4% vs 4.2%).
• Teens with hypertension, sleep apnea or chronic steroid use were more likely to be readmitted, and sleeve gastrectomy carried lower readmission odds than gastric bypass in both age groups.

What This Means for Teens and Families

Surgery is not riskier for teenagers than for adults; the study found the opposite trend on readmissions. The bigger risk is waiting. Teens in this study reached surgery heavier and with more established disease than adults, and comorbidities were linked to more readmissions. Referring earlier, before diabetes, sleep apnea and high blood pressure take hold, is likely to be both safer and more effective. If your child has severe adolescent obesity, review our Am I a Candidate? guide and our article on what BMI means for surgical options.

Clinical Pearls

• Fewer than 2 in 1,000 US youth with class II/III obesity received surgery in 2015–2018.
• 30-day safety in adolescents matched or exceeded adults in a national registry of nearly 750,000 patients.
• Ethnic minority teens face the widest gap between need and access.
• Delayed referral means higher BMI and more comorbidities at the time of surgery.

Strengths and Limitations

This is one of the first studies to calculate national adolescent utilization by linking population survey data with a nationwide surgical registry, and it compares youth and adults within the same accredited system. It captures only 30-day outcomes, so long-term results come from other work such as our 10- to 18-year follow-up of adolescent patients and the Teen-LABS study. Operations at non-accredited centers are not counted, though roughly 80% of US bariatric operations are performed at MBSAQIP centers.

Expert Commentary

This study put a number on something I saw every week in clinic: the young people who need surgery most are the least likely to be offered it. In Miami, many of my adolescent patients are Hispanic or Black, and this analysis confirms that nationally those are exactly the teens being left behind.

What I want pediatricians and parents to take from this paper is that adolescents do as well as adults in the first month after surgery. The risk lies in waiting until a teen is 50 or 60 pounds heavier and already on medications for blood pressure or diabetes.

— Dr. Nestor de la Cruz-Muñoz

Related Research

• 2023 JAMA Pediatrics research letter
• 2025 Journal of Pediatrics study
• 10- to 18-year follow-up of adolescent patients