Severe obesity in adolescents is a public health crisis of increasing concern. Cardiac maladaptation, such as left ventricular hypertrophy, increases the risk of future cardiovascular disease. This study aims to evaluate the impact of weight loss surgery on cardiac geometry in morbidly obese adolescents.

A single-centre, randomised controlled trial titled comparing laparoscopic adjustable gastric banding with multidisciplinary lifestyle intervention against a control group with multidisciplinary lifestyle intervention alone. The trial included severely obese adolescents aged 14–16 who had not responded to a minimum of 12 months of multidisciplinary lifestyle intervention. The primary outcome measured was the percentage change in total body weight one year after surgery. Left ventricular geometry was evaluated ultrasonographically before and one year after bariatric surgery.

In the intervention and control group, a total of 10 and 8 patients received both the baseline and follow-up ultrasonographic examination. BMI significantly decreased in the intervention group compared to the control group (−6.75; 95% CI: -10.28 – −3.23). Moreover, left ventricular mass index (−8.21; 95% CI: −15.43 – −0.98) and relative left ventricular wall thickness (−0.04; 95% CI: −0.07 – 0.00) significantly decreased within the intervention group, reflecting amelioration of adverse remodelling, albeit without statistically significant intervention effect when compared to the control group.

Significant weight loss through bariatric surgery may improve left ventricular geometry in severely obese adolescents. These findings support the potential of bariatric surgery not only for reducing weight loss but also for improving cardiac health.

To study the demographic and clinical parameters of three different categories of obesity, with particular focus on a cohort of individuals with BMI ≥ 50 kg/m2, the fastest growing category of obesity.

Over 700 obese individuals were studied (186 with BMI = 30–39 kg/m2, 316 with BMI = 40–49 kg/m2 and 290 with BMI ≥ 50 kg/m2).

Median BMI was 51 kg/m2 for patients who reported onset of overweight before 15 years of age, 47 kg/m2 for patients who reported onset between 15 and 30 years, and 42 kg/m2 for patients who became overweight after 30 years of age. The BMI ≥ 50 kg/m2 group was notably younger than the group with BMI = 30–39 kg/m2 (44 (sd 11) years v. 50 (sd 15) years; P < 0·0001). Eighteen per cent of obese patients studied were considered metabolically healthy according to standard cut-off points for blood pressure, fasting glucose and lipid profiles. However, the proportion of metabolically healthy individuals was significantly higher in the BMI = 30–39 kg/m2 group than in the BMI = 40–49 kg/m2 and BMI ≥ 50 kg/m2 groups (31 % v. 17 % and 12 % respectively; P < 0·05 and P < 0·005). When compared with people of similar age in the general population, individuals with BMI ≥ 50 kg/m2 had lower rates of marriage (51 % v. 72 %) and a higher prevalence of unemployment (14 % v. 5 %).

The current study suggests that the increasing prevalence of childhood obesity worldwide will lead to many more individuals achieving a higher BMI at a younger age. Furthermore, an earlier onset of overweight does not appear to prevent the adverse metabolic health outcomes associated with extreme obesity.