Controlled Trial of WLS vs. CLI for Severely Obese Adolescents With NASH

Inclusion Criteria: * Adolescents ages 12-19 years (range as defined by World Health Organization). * BMI ≥ 35 to 69 kg/m2 (minimum BMI per current guidelines for WLS in adolescents). An upper limit of BMI was set to avoid rare outliers in BMI. * Meet current standard of care eligibility criteria for adolescent WLS. * Liver biopsy for clinical indication to evaluate for NASH within 1 year of enrollment. Biopsy must confirm definite or borderline NASH with a minimum histological NASH Activity Score of ≥ 3. * No evidence of any other liver disease by history, screening tests or histological evaluation. * Written informed consent from parent/legal guardian and informed assent from the adolescent Exclusion Criteria: * Evidence of other chronic liver disease: autoimmune hepatitis; hepatitis B; hepatitis C; hemochromatosis; alpha-1-antitrypsin (A1AT) deficiency; Wilson disease; use of medications known to cause fatty liver for \> 2 consecutive weeks in past year (i.e. systemic glucocorticoids, tetracycline, anabolic steroids, valproic acid); alcohol intake \>10 gm/day females \& \>20 gm/day males. * Non-compensated liver disease with any of the following: hemoglobin \<10 g/dL; white blood cell count \<3,500 cells/mm3, platelet count \<130,000 cells/mm3 of blood, direct bilirubin \>1.0 mg/dL, total bilirubin \>3 mg/dL, albumin \<3.2 g/dL, international normalized ratio (INR) \>1.4 * Active psychiatric disorder that would prevent eligibility for WLS or impede adherence to CLI, inc…