Synthesized Cardiometabolic, Pulmonary, and Sleep Outcomes After Bariatric Surgery in Adolescents With Severe Obesity: A Systematic Review and Meta-analysis

ABSTRACT Background To synthesize cardiometabolic, pulmonary, sleep-related, anthropometric, and safety outcomes after metabolic and bariatric surgery in adolescents with severe obesity. Methods This was a systematic review and meta-analysis conducted according to PRISMA 2020 and prospectively registered in PROSPERO (CRD420261354795). Five databases were searched for studies of adolescents aged approximately 10–19 years undergoing recognized metabolic or bariatric procedures. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analysis was used when studies were sufficiently comparable. Results Of 5,110 records, 147 reports representing 101 unique studies or cohorts published from 1995–2026 were included. Follow-up ranged from 30 days to approximately 15 years. Across three independent randomized cohorts, surgery reduced body mass index by 9.39 kg/m 2 at 2 years versus non-surgical care (95% CI −13.90 to −4.89; I 2 =88%; low certainty). Randomized evidence indicated lower triglycerides (mean difference −0.36 mmol/L, 95% CI −0.57 to −0.14; low certainty), whereas blood-pressure effects were indeterminate (very low certainty). Observational cohorts reported improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea. Weight reduction was durable after gastric bypass and sleeve gastrectomy but smaller and less durable after gastric banding. Repeat objective sleep testing was reported in three studies and postoperative spirometry in one. No included report documented use of a validated asthma-control instrument, ambulatory blood-pressure monitoring, or vascular imaging as a pre- and postoperative outcome; diastolic function was reported once; diastolic function was reported once. Perioperative mortality and serious 30-day complications were uncommon, whereas reoperation and micronutrient deficiency remained important during extended follow-up. Conclusions Metabolic and bariatric surgery produces large body mass index reductions and multisystem improvement in adolescents with severe obesity; serious short-term complications and perioperative mortality were uncommon, but lifelong nutritional and multidisciplinary surveillance remains important. Most effect estimates remain uncertain, particularly for objective long-term sleep and pulmonary outcomes.