National Trends and Outcomes of Metabolic and Bariatric Surgery in Adolescents: Insights from the Israeli National Bariatric Surgery Registry

Background: Severe obesity among adolescents is an increasing global health concern associated with significant metabolic and psychosocial morbidity. Metabolic and bariatric surgery (MBS) has emerged as the most effective treatment for durable weight-loss in selected adolescents; however, national data on trends and outcomes remain limited. We aim to evaluate national trends, characteristics, and outcomes of adolescent MBS in Israel using the Israel National Bariatric Surgery Registry (INBSR). Methods: We conducted a nationwide retrospective analysis of adolescents (< 18 years-old) who underwent MBS between 2017 and 2024. Data were extracted from the INBSR, a mandatory registry capturing procedures across all centers. Baseline demographics, obesity-related diseases, procedures, and weight-loss outcomes were analyzed. Results: A total of 460 adolescents underwent primary MBS. Mean age was 16.9 ± 0.8 years and mean body mass index was 46.4 ± 6.8 kg/m², with a female predominance (58.7%). Sleeve gastrectomy (SG) was most common (87.6%). Comorbidity burden was high, including fatty liver disease (60–73.8%), obstructive sleep apnea (~ 51.3%), and type 2 diabetes (~ 20%). SG achieved mean excess weight loss (%EWL) of 56.3% at 6 months, 70.7% at 2 years, and 68.5% at 4 years. Other procedures demonstrated greater weight-loss (~ 80% EWL at 3 years). Follow-up declined, with dietitian visits decreasing from 47.6% at 1 year to 14.5% at 4 years. Sixteen patients required revisional surgery mainly due to recureent weight gain. Conclusions: Adolescent MBS in Israel results in substantial and durable weight-loss. However, high comorbidity burden and poor long-term follow-up highlight the need for improved multidisciplinary care and retention strategies.