The Evolving Role of Bariatric Surgery in Children and Adolescents Amid the Rise of GLP-1 Receptor Agonists
A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.62.73665Keywords
adolescent obesity, bariatric surgery, pediatric obesity, metabolic surgery, GLP-1 receptor agonists, semaglutide, liraglutide, sleeve gastrectomy, type 2 diabetesAbstract
Background. Pediatric obesity is a chronic, progressive disease associated with metabolic, cardiovascular, orthopedic and psychosocial complications. Metabolic and bariatric surgery can provide substantial and durable weight reduction in adolescents with severe obesity, but it is invasive and requires lifelong follow-up. The growing availability of glucagon-like peptide-1 receptor agonists may influence the role of surgery.
Aim. This narrative review summarizes evidence on the indications, outcomes and complications of bariatric surgery in children and adolescents and discusses its evolving role in the era of GLP-1 receptor agonist therapy.
Material and methods. PubMed, Scopus and Web of Science were searched for articles published between 2016 and 2026. Landmark studies and guidelines published before 2016 were also included. The search covered pediatric obesity, adolescent bariatric surgery, sleeve gastrectomy, Roux-en-Y gastric bypass, complications, type 2 diabetes, liraglutide, semaglutide and GLP-1 receptor agonists.
Results. Metabolic and bariatric surgery provides the most established long-term evidence for substantial weight loss and improvement of obesity-related complications in adolescents with severe obesity. Liraglutide and semaglutide produce clinically meaningful short-term BMI reductions and may serve as alternatives or components of multimodal care. Surgery is also associated with improved mobility, physical function, musculoskeletal pain and health-related quality of life, whereas evidence on objectively measured fitness, participation in sport and routine perioperative use of GLP-1 receptor agonists remains limited.
Conclusions. GLP-1 receptor agonists do not eliminate the need for metabolic and bariatric surgery in pediatric patients but may change treatment sequencing and shared decision-making. Care should be individualized, multidisciplinary and guided by effectiveness, psychological well-being and long-term safety.
References
1. Garrido-Miguel M, Cavero-Redondo I, Álvarez-Bueno C, Rodríguez-Artalejo F, Moreno LA, Ruiz JR, et al. Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(10):e192430. https://doi.org/10.1001/jamapediatrics.2019.2430.
2. Kelly AS, Armstrong SC, Michalsky MP, Fox CK. Obesity in Adolescents: A Review. JAMA. 2024;332(9):738-748. https://doi.org/10.1001/jama.2024.11809.
3. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. https://doi.org/10.1542/peds.2022-060640.
4. Braddock A, Browne NT, Houser M, Blair G, Williams DR. Weight stigma and bias: A guide for pediatric clinicians. Obes Pillars. 2023;6:100058. https://doi.org/10.1016/j.obpill.2023.100058.
5. Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr. 2024;36(1):42-48. https://doi.org/10.1097/MOP.0000000000001305.
6. Foster T, Leane C, Khawaja N, Na M, Trompeter N, Yager Z, et al. The relationship between internalised weight bias and biopsychosocial health outcomes in individuals up to 25 years: A systematic review. J Eat Disord. 2024;12:39. https://doi.org/10.1186/s40337-023-00959-w.
7. Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis. 2018;14(7):882-901. https://doi.org/10.1016/j.soard.2018.03.019.
8. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity and Metabolic Disorders: Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356. https://doi.org/10.1016/j.soard.2022.08.013.
9. Chinn JO, Woo Baidal J, Pratt JSA, Shepard WE, Fell GL. Pediatric Metabolic and Bariatric Surgery and Antiobesity Medications: Weighing Efficacy, Risks, and Future Directions. J Pediatr. 2025;283:114610. https://doi.org/10.1016/j.jpeds.2025.114610.
10. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med. 2016;374(2):113-123. https://doi.org/10.1056/NEJMoa1506699.
11. Inge TH, Courcoulas AP, Jenkins TM, et al. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med. 2019;380(22):2136-2145. https://doi.org/10.1056/NEJMoa1813909.
12. Ryder JR, Jenkins TM, Xie C, et al. Ten-Year Outcomes after Bariatric Surgery in Adolescents. N Engl J Med. 2024;391(17):1656-1658. https://doi.org/10.1056/NEJMc2404054.
13. Xanthakos SA, Khoury JC, Inge TH, et al. Nutritional Risks in Adolescents After Bariatric Surgery. Clin Gastroenterol Hepatol. 2020;18(5):1070-1081.e5. https://doi.org/10.1016/j.cgh.2019.10.048.
14. Wasserman H, Jenkins T, Inge T, et al. Bone Mineral Density in Young Adults 5 to 11 Years after Adolescent Metabolic and Bariatric Surgery for Severe Obesity Compared with Peers. Int J Obes (Lond). 2024;48(4):575-583. https://doi.org/10.1038/s41366-023-01453-8.
15. Inge TH, Zeller MH, Jenkins TM, et al. Perioperative Outcomes of Adolescents Undergoing Bariatric Surgery: The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr. 2014;168(1):47-53. https://doi.org/10.1001/jamapediatrics.2013.4296.
16. Kelly AS, Auerbach P, Barrientos-Perez M, Gies I, Hale PM, Marcus C, et al. A Randomized, Controlled Trial of Liraglutide for Adolescents with Obesity. N Engl J Med. 2020;382(22):2117-2128. https://doi.org/10.1056/NEJMoa1916038.
17. Weghuber D, Barrett T, Barrientos-Perez M, Gies I, Hesse D, Jeppesen OK, et al. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med. 2022;387(24):2245-2257. https://doi.org/10.1056/NEJMoa2208601.
18. Kompaniyets L, Pierce SL, Porter R, Autrey K, Chua KP, Belay B, Blanck HM, Goodman AB. Prescriptions for Obesity Medications Among Adolescents Aged 12-17 Years with Obesity - United States, 2018-2023. MMWR Morb Mortal Wkly Rep. 2025;74(20):337-344. https://doi.org/10.15585/mmwr.mm7420a1.
19. European Medicines Agency. Saxenda (liraglutide): EPAR - medicine overview [Internet]. Amsterdam: European Medicines Agency; 2025 [cited 2026 Jun 23]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/saxenda.
20. European Medicines Agency. Wegovy (semaglutide): EPAR - medicine overview [Internet]. Amsterdam: European Medicines Agency; 2023 [cited 2026 Jun 23]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/wegovy.
21. Wilding JPH, Batterham RL, Davies M, et al. Weight Regain and Cardiometabolic Effects after Withdrawal of Semaglutide: The STEP 1 Trial Extension. Diabetes Obes Metab. 2022;24(8):1553-1564. https://doi.org/10.1111/dom.14725.
22. Ogle S, Schmoke N, Inge T. Adolescent Bariatric Surgery. In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2025. Updated 2025 Jan 19 [cited 2026 Jun 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK575728/.
23. McCarty TR, Jirapinyo P, Thompson CC. Effect of Sleeve Gastrectomy on Ghrelin, GLP-1, PYY, and GIP Gut Hormones: A Systematic Review and Meta-analysis. Ann Surg. 2020;272(1):72-80. https://doi.org/10.1097/SLA.0000000000003614.
24. Alqahtani A, Elahmedi M, Alqahtani YA, Al-Darwish A. Endoscopic Sleeve Gastroplasty in 109 Consecutive Children and Adolescents With Obesity: Two-Year Outcomes of a New Modality. Am J Gastroenterol. 2019;114(12):1857-1862. https://doi.org/10.14309/ajg.0000000000000440.
25. Oyola C, Berry M, Paez Salazar MA, De Abreu D, Formiga A, Escalona A, Rodriguez M, Ienca R. Successful Weight Loss in Adolescents with Overweight or Obesity Using a Swallowable Intragastric Balloon and Nutritional Oversight. Obes Surg. 2024;34(10):3762-3770. https://doi.org/10.1007/s11695-024-07458-0.
26. Siretskiy R, Alonso D, Calisto J, Lau PE. Complication of Gastric Balloon in an Adolescent Patient: A Case Report. Cureus. 2024;16(11):e73743. https://doi.org/10.7759/cureus.73743.
27. Zenno A, Nwosu EE, Fatima SZ, et al. An Open-Label 16-Week Study of Liraglutide in Adolescents with Obesity Post-Sleeve Gastrectomy. Pediatr Obes. 2024;19(11):e13154. https://doi.org/10.1111/ijpo.13154.
28. Vidmar AP, Vu MH, Martin MJ, et al. Early Reinitiation of Obesity Pharmacotherapy Post Laparoscopic Sleeve Gastrectomy in Youth: A Retrospective Cohort Study. Obes Surg. 2025;35(2):406-418. https://doi.org/10.1007/s11695-024-07658-8.
29. Dutta D, Nagendra L, Joshi A, et al. Glucagon-Like Peptide-1 Receptor Agonists in Post-Bariatric Surgery Patients: A Systematic Review and Meta-analysis. Obes Surg. 2024;34(5):1653-1664. https://doi.org/10.1007/s11695-024-07175-8.
30. Vidmar AP, Batt CE, Moore JM. Assessment and Medical Management of Weight Regain after Adolescent Metabolic and Bariatric Surgery: A Narrative Review. Surg Obes Relat Dis. 2025;21(1):24-32. https://doi.org/10.1016/j.soard.2024.10.008.
31. Chinn JO, Shacker M, Brennan KA, et al. The Impact of Preoperative Antiobesity Medications on Weight Loss in Adolescents Undergoing Metabolic and Bariatric Surgery: A COSMIC Study. Surg Obes Relat Dis. 2026;22(2):264-272. https://doi.org/10.1016/j.soard.2025.10.014.
32. Boles RE, Moore JM. Psychosocial outcomes after adolescent metabolic and bariatric surgery: A narrative review of the literature. Surg Obes Relat Dis. 2025;21(1):16-23. https://doi.org/10.1016/j.soard.2024.09.003.
33. Ryder JR, Edwards NM, Gupta R, et al. Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA Pediatr. 2016;170(9):871-877. https://doi.org/10.1001/jamapediatrics.2016.1196.
34. Bout-Tabaku S, Gupta R, Jenkins TM, et al. Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery. Pediatrics. 2019;144(6):e20191399. https://doi.org/10.1542/peds.2019-1399.
35. Zeller MH, Reiter-Purtill J, Jenkins TM, Kidwell KM, Bensman HE, Mitchell JE, et al. Suicidal thoughts and behaviors in adolescents who underwent bariatric surgery. Surg Obes Relat Dis. 2020;16(4):568-580. https://doi.org/10.1016/j.soard.2019.12.015.
36. Czepczor-Bernat K, Mikulska M, Matusik P. Analysis of Blame, Guilt, and Shame Related to Body and Body Weight and Their Relationship with the Context of Psychological Functioning Among the Pediatric Population with Overweight and Obesity: A Systematic Review. Nutrients. 2025;17(11):1763. https://doi.org/10.3390/nu17111763.
37. Fox CK, Barrientos-Pérez M, Bomberg EM, Dcruz J, Gies I, Harder-Lauridsen NM, Jalaludin MY, Sahu K, Weimers P, Zueger T, Arslanian S. Liraglutide for Children 6 to <12 Years of Age with Obesity - A Randomized Trial. N Engl J Med. 2025;392(6):555-565. https://doi.org/10.1056/NEJMoa2407379.
38. Maffeis C, Olivieri F, Valerio G, et al. The treatment of obesity in children and adolescents: consensus position statement of the Italian Society of Pediatric Endocrinology and Diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery. Ital J Pediatr. 2023;49(1):69. https://doi.org/10.1186/s13052-023-01458-z.
39. Ministry of Health of Poland. Communication of the Minister of Health on the availability and reimbursement of GLP-1 receptor analogue medicines [Internet]. Warsaw: Ministry of Health of Poland; 2024 Aug 26 [cited 2026 Jun 23]. Available from: https://www.gov.pl/web/zdrowie/komunikat-ministra-zdrowia-w-sprawie-dostepnosci-i-refundacji-lekow-z-grupy-analogow-glp-1. Polish.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Joanna Jabłońska, Joanna Wasik, Marta Armuła, Claire Bongage, Arkadiusz Piechowiak, Filip Napieraj, Bartosz Przemysław Herc, Małgorzata Tesla, Anna Agnieszka Gąska, Marta Gutkowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 77
Number of citations: 0
