Assessing Hepatic Steatosis Following Weight Loss in Adolescents with Severe Obesity: A Randomized Controlled Trial

To assess whether laparoscopic adjustable gastric banding (LAGB) and combined lifestyle intervention (CLI) reduce hepatic steatosis more effectively than CLI alone in adolescents with severe obesity.

Adolescents aged 14-16 with a BMI ≥ 40 kg/m² (or ≥35 kg/m² with comorbidity) were randomized to receive LAGB + combined lifestyle intervention (CLI, n = 30) or CLI alone (n = 30). Hepatic fat was assessed at baseline and one year via ultrasound-based Hepatorenal Index (HRI), liver span, and ALAT levels.

Of 59 participants (mean age 15.7, 80% female, BMI 44.3 kg/m²), 58.9% had steatosis at baseline (HRI ≥ 1.40). After one year, BMI decreased by 5.6 kg/m² in the LAGB group but remained stable in controls. Steatosis resolution (HRI < 1.05) occurred in 21.4% of LAGB versus 4.4% of CLI patients (p = 0.078). Liver span declined by 1.09 cm post-LAGB (95% CI -2.05 to -0.13) and correlated with HRI improvement. ALAT levels were unchanged.

LAGB led to greater reductions in hepatic fat and size than lifestyle changes alone. Though steatosis resolution was not statistically significant, findings suggest bariatric surgery may be a promising strategy for mitigating early hepatic changes in severe adolescent obesity.

Severe obesity in adolescents is frequently accompanied by hepatic steatosis, which can progress to metabolic dysfunction-associated steatotic liver disease (MASLD). Bariatric procedures-such as laparoscopic adjustable gastric banding (LAGB)-are proven to induce substantial weight loss and improve obesity-related comorbidities in youth.

This is the first randomized controlled trial to evaluate the effect of LAGB on hepatic steatosis specifically in adolescents. At one year, 21.4% of LAGB-treated patients no longer met the sensitive HRI cut-off for steatosis (<1.05) versus 4.4% of controls. Moderate weight loss after LAGB corresponded with significant improvements in the Hepatorenal Index and liver span, suggesting a reduction in hepatic fat content.