Marijuana, E-Cigarette and Tobacco Product Use In Young Adults Who Underwent Pediatric Bariatric Surgery

Published:November 18, 2022DOI:


      • Concerning prevalence of conventional cigarettes and marijuana use
      • Persistent use over time and/or heavy use were not uncommon among users
      • A sizable minority used >1 alternate tobacco product/device
      • Tobacco product use but not marijuana use were related to weight outcomes



      The post-operative course following pediatric metabolic and bariatric surgery (MBS) cuts across a developmental phase when substance use behaviors emerge as significant public health concerns.


      We examined use of marijuana, conventional cigarettes, and alternate tobacco products/devices (e.g., e-cigarettes, hookah, smokeless, dissolvable) in young adults (YA) to 6 years post-surgery.


      5 academic medical centers


      In a prospective observational cohort series, 139 surgical (Mage=16.9, Mbodymassindex[BMI] = 51.5, 80% female, 66% white) and 83 non-surgical comparisons (Mage=16.1, MBMI= 44.9, 82% female, 54% white) completed assessments at presurgery/baseline and postsurgery Years 2, 4, and 6 (Year 6 [2014-2018]: surgical n=123 [89%] Mage=23.0, MBMI=39.8); nonsurgical n=63 [76%]; Mage=22.4, MBMI= 53.6). Lifetime and current (past 30-day) use were reported.


      Consistent with national YA trends (2014-2018), the most commonly used were conventional cigarettes (30% surgical; 41% nonsurgical, ns), marijuana (25% surgical; 27% nonsurgical, ns), and e-cigarettes (12% surgical; 10% nonsurgical). A sizable minority (26% surgical, 18% non-surgical) used >1 alternate tobacco product/device. Many YA reported persistent and/or heavy use (e.g., >50% marijuana at Year 6 and also Year 2 or 4; ≈ 50% >½ pack per day cigarettes), suggesting more established (versus intermittent) health risk behaviors. For the surgical group at Year 6, current tobacco product/device use was associated with lower BMI (p<.001) and greater percent weight loss (p=0.002).


      Pediatric MBS demonstrates promise in lowering risks for adult chronic disease which may be diminished by age-typical health risk behaviors. Developmentally salient and holistic pediatric post-operative care guidelines are needed.


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