According to a recent study, adolescents and young adults with considerable weight loss following bariatric Surgery had weaker bones than those with comparable degrees of obesity who did not undergo surgery.

With that being said, according to the study’s primary author, Dr. Miriam Bredella, Bariatric Surgery should not be avoided for young people who are severely obese.

Bredella said that “Totally get the surgery — diabetes and heart disease cause much more morbidity and mortality than osteoporosis, and type 2 diabetes is also bad for your bones. Our study was not to say, ‘Don’t get bariatric surgery,’ but to say ‘Hey, if you get the surgery, just make sure you have a healthy diet, you do weight-bearing exercise, and you get enough vitamin D and calcium.”

According to Dr. Thomas Inge, significant weight reduction for whatever reason causes bones to weaken as the body adapts to the new reality of not carrying additional weight.

Inge, who was not involved in the study, shared that “NASA scientists are very worried about this issue with sending human beings into space. Bone mass and density can decline within weeks, and that’s why they have astronauts trying to mitigate the bone loss that happens when they’re weightless with physical activity.”

In the study, which was released in the journal Radiology, the bone health of 25 participants aged 13 to 25 who underwent bariatric weight reduction surgery was compared to that of 29 participants in the same age range who didn’t.

All were given nutrition and exercise coaching, and after two years, they were all reevaluated.

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Teenagers and young adults who didn’t have weight loss surgery over those 2 years continued to gain weight in spite of counseling, the study revealed.

But those who underwent surgery lost almost 20 BMI points, which is astounding, according to Bredella. Body mass index, or BMI, is a rough estimation of a patient’s body fat based on height and weight.

“Some of these kids had a BMI of 50 or 60 and lost so much weight they got down to a BMI of 30 or 35, which is huge. Unfortunately, a BMI of 30 and 35 is still obese,” she said.

Dr. Justin Ryder said that the study’s result is not surprising.

Ryder, who was not involved in the research, stated that “If you think about it, they basically taken a big, heavy backpack off of themselves. So, they need to find a way to put some of that weight back on the bones through strength and resistance training.”

What was unexpected, according to Bredella, is that although the difference was not statistically significant, the bones of the youngsters who did not have surgery and kept gaining weight also deteriorated.

“Why would their bones not get stronger? Because obesity itself is bad for bones. Obesity is an inflammatory state and we have done studies that show the inflammation negatively influences bone health.”

According to Bredella, the sort of visceral fat associated with extreme obesity also decreases the release of growth factor hormones, which are essential for strong bones.

The precise research on bone loss in adolescents and young adults is challenging, however.

Ryder said that “Kids in this age range haven’t reached full maturity of their bones yet. You don’t hit peak bone formation until your late 20s or early 30s. So, it’s really challenging to study the impact of weight loss surgery on bone health in this variable period where they’re still building bone and the density of those bones.”

If the bone loss reported in the latest study persists, a study would have to follow youngsters who underwent surgery for at least ten years, Inge said.

Inge stated that “With just two years of follow-up, this study unfortunately doesn’t really shed light on whether the drop that we’re seeing is pathologic or to be expected as the bones get back to normal density.”

The marrow of the bones contained more fat in young patients who underwent sleeve surgery, by far the most popular kind of bariatric surgery performed today.

Despite having significantly decreased their weight and BMI, which lowered their overall body fat, Bredella noted that these patients had more fatty yellow marrow in their bones.

She went on to explain that there are two different forms of bone marrow: red marrow, which is where our stem cells produce new white and red blood cells to refill the body, and fatty marrow, which is more of a yellow tint.

Bredella “We used to think fatty marrow within bones was just filler with no function. But we know now that it’s an endocrine organ — it secretes hormones of different kinds and is associated with making bones weaker. Why did fatty marrow increase inside the bones of children who had sleeve surgery? That’s the million-dollar question we have to answer,” she said.

When gastric bypass surgery first gained popularity, it skipped the duodenum, a crucial part of the small intestine for absorbing micronutrients including vitamins and minerals.

According to Inge, the more recent sleeve operation allows for the removal of a piece of the stomach without compromising the duodenum, increasing food absorption of nutrients. 

Additionally, during sleeve surgery, portions of the stomach that transmit certain hunger signals to the brain are eliminated, which lowers appetite and food cravings.

However, several minerals, such as calcium and the vitamins D and B12, are deficient after surgery and must be supplemented.

“We do worry long term about adequacy of micronutrients in general, and calcium and vitamin D in particular. That’s why we insist that people undergoing weight loss surgery take their multivitamin with calcium and vitamin D every day, just like medicine,” Inge also stated.

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