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Teenagers who undergo gastric bypass and other weight loss surgeries are able to keep the pounds off years after the procedures, a new study suggests. Researchers tracked 228 teens who had bariatric surgery over three years and found that they lost more than 90 pounds on average from a starting average weight of almost 330 pounds. The study, published in the New England Journal of Medicine, found that many who had obesity-related diseases like diabetes were able to vastly improve their illnesses and keep them at bay years later.

The new study also showed some risks; after surgery, about half of the participants had low iron levels, while fewer than 5% did at the start. Many people in the study also required additional surgeries, such as gallbladder removal.

More research is needed—especially randomized controlled trials in diverse populations—but this study suggests that weight-loss surgeries can offer many of the same benefits for teens as they do for adults, even though teenagers’ bodies are still developing. However, doctors warn that weight-loss surgery should remain a last resort after efforts such as diet and exercise have proven ineffective.

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