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Assessed for eligibility (n=100)

Adolescents- Surgery. Adolescents- Controls. Adults- Surgery. Assessed for eligibility (n=100). Adults identified from the Swedish Obesity Surgery Register (SOReg) (n=81). Adolescents identified from the Swedish Childhood Obesity Treatment Register (BORIS) (n=81). Enrollment.

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Assessed for eligibility (n=100)

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  1. Adolescents-Surgery Adolescents- Controls Adults- Surgery Assessed for eligibility (n=100) Adults identified from the Swedish Obesity Surgery Register (SOReg) (n=81) Adolescents identified from the Swedish Childhood Obesity Treatment Register (BORIS) (n=81) Enrollment Excluded (n =18) Decline to participate Allocated to intervention (n=82) Allocation Excluded (n =1) Declines surgery Surgical intervention: laparoscopic Roux-en-Y gastric bypass (n=81) Intervention Visit 1 yr (n=81) (n=81) (n=81) Follow-Up 2 yr 1 yr Visit 2 yr (n=81) (n=59) (n=81) eFigure1: CONSORT flow chart of patients in study

  2. Relative weight change: Women Men 15 15 Control, adolescents (AC) Control, adolescents AC Gastric bypass, adolescents (GBA) Gastric bypass, adolescents GBA 10 10 Gastric bypass, adults Gastric bypass, adults (GBC) GBC 5 5 0 0 - 5 - 5 - 10 - 10 - 15 - 15 Relative weight change, % - 20 - 20 - 25 - 25 - 30 - 30 - 35 - 35 - 40 - 40 0 1 2 0 1 2 Body mass index: 50 50 45 45 40 40 ) 2 35 35 30 30 25 25 Body mass index (kg/m 20 20 15 15 10 10 5 5 AC AC GBA GBA 0 0 GBC GBC 0 1 2 0 1 2 Patients, n: Follow - up, years Follow - up, years AC 46 46 31 35 35 28 GBA 53 53 53 28 28 28 GBC 53 53 53 28 28 28 eFigure 2 Relative weight changes and body mass index in adolescents and adults undergoing gastric bypass surgery, split by gender

  3. Insulin Insulin Insulin Insulin Glucose Glucose Glucose Glucose HbA1c HbA1c HbA1c HbA1c Lpk Lpk Lpk Lpk CRP CRP CRP CRP 50 50 50 50 6 6 6 6 5 5 5 5 10 10 10 10 10 10 10 10 Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls 9 9 9 9 9 9 9 9 5 5 5 5 8 8 8 8 40 40 40 40 4 4 4 4 8 8 8 8 7 7 7 7 7 7 7 7 4 4 4 4 6 6 6 6 30 30 30 30 3 3 3 3 6 6 6 6 5 5 5 5 3 3 3 3 5 5 5 5 /l /l /l /l 10*9/l 10*9/l mg/l mg/l % % mU mU ) ) mmol mmol 4 4 4 4 20 20 20 20 2 2 2 2 4 4 4 4 2 2 2 2 3 3 3 3 3 3 3 3 2 2 2 2 10 10 10 10 1 1 1 1 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 2 2 2 2 0 0 0 0 1 1 1 1 2 2 2 2 0 0 0 0 1 1 1 1 2 2 2 2 0 0 0 0 1 1 1 1 2 2 2 2 0 0 0 0 1 1 1 1 2 2 2 2 2 2. 2 0 0 3. 5 2. 0 140 140 90 90 Triglycerides LDL HDL Systolic Systolic Systolic Systolic BP Diastolic Diastolic Diastolic Diastolic BP BP BP BP 80 80 80 80 80 80 3 3. 0 0 0 120 120 120 120 120 120 70 70 70 70 70 70 1 1. 5 5 1 1. 1 5 5 5 2. 2 2 5 5 5 100 100 100 100 100 100 60 60 60 60 60 60 2. 2 2 0 0 0 80 80 80 80 80 80 50 50 50 50 50 50 1 1 1. 0 0 0 1 0 · 40 40 40 40 40 40 mmHg mmHg 1 1. 1 5 5 5 60 60 60 60 60 60 mmol/l mmol/l mmol/l 30 30 30 30 30 30 1 1 1. 0 0 0 40 40 40 40 40 40 0 0 0. 5 5 5 0. 0 0 5 5 5 20 20 20 20 20 20 0 0. 0 5 5 5 20 20 20 20 20 20 10 10 10 10 10 10 Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls 0 0. 0 0 0 0 0 0 0. 0 0 0 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Follow Follow Follow Follow Follow -up, -up, -up, -up, -up, years years years years years eFigure3 Biochemical and blood pressure data in adolescents after gastric bypass surgery, split by gender

  4. eFigure 4 Quality of life data (SF-36) in adolescents after gastric bypass surgery, split by gender Physical functioning (PF) Role-physical (RP) Bodily Pain (BP) General Health (GH) 100 100 100 100 80 80 80 80 60 60 60 60 36 Score - Mean SF 40 40 40 40 20 20 20 20 Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls 0 0 0 0 0 1 2 0 1 2 0 1 2 0 1 2 Vitality (VT) Social Functioning (SF) Mental Health (MH) Role Emotional (RE) 100 100 100 80 80 80 80 60 60 60 60 36 Score - Mean SF 40 40 40 40 20 20 20 20 Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Boys Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls Girls 0 0 0 0 0 1 2 0 1 2 0 1 2 0 1 2 Follow Follow - - up, years up, years Follow Follow - - up, years up, years

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