Metabolic syndrome (MetS) affects 10% of adolescents and is associated with development of diabetes and heart disease. Abdominal obesity, representing excess visceral fat, is the most prevalent component of MetS. Sagittal abdominal diameter (SAD) is highly correlated with visceral fat, yet its use in the clinical setting is largely nonexistent. We aimed to determine MetS prevalence and association between MetS severity and SAD in adolescents undergoing bariatric surgery.


We examined data from Teen Longitudinal Assessment of Bariatric Surgery (Teen LABS) study participants through 5 years post-bariatric surgery. MetS prevalence was defined using standard criteria and MetS severity using the MetS z-score (Met-z). The association between SAD and Met-z was evaluated using a linear mixed model, adjusting for covariates including sex and age at surgery.


Among 228 individuals, mean age 16.5y and BMI 53 kg/m2 at baseline (75% female, 72% white), 65% met criteria for MetS. Mean pre-surgery Met-z was +1.5 and SAD was 32cm. Both significantly declined by 1 year, to Met-z of -0.02 and SAD 23cm. At 5 years after surgery, Met-z was +0.15 and SAD 25cm, (both p < 0.0001 compared to baseline). Met-z and SAD were highly correlated at all timepoints (r = 0.72 overall, p < 0.0001)


Adolescents undergoing bariatric surgery have a high MetS prevalence. Major reductions in MetS and SAD were observed out to 5 years post-surgery and these two measures were consistently highly correlated over time. SAD may be a valuable tool to predict MetS in youth with obesity.