Beyond Infection Control: Favorable Weight Outcomes After Tonsillectomy for Recurrent and Chronic Tonsillitis in Children

Introduction: Recurrent or chronic tonsillitis is a common pediatric condition often treated with tonsillectomy. The impact of tonsillectomy on subsequent long term weight outcomes, including obesity risk, remains incompletely understood.

Methods: This retrospective cohort study used de-identified electronic health record data from the TriNetX US Collaborative Network and included pediatric patients ( < 18 years) diagnosed with recurrent or chronic tonsillitis between January 2015 and December 2026, excluding those with obesity prior to the index date. Patients were categorized by treatment with tonsillectomy or non-surgical management, propensity score matched for relevant clinical and demographic variables, and followed for incident obesity within 24 months after the index date.

Results: After propensity score matching, baseline demographic and clinical characteristics were well balanced between the tonsillectomy and non-surgical cohorts. At 24 months of follow-up, pediatric patients who underwent tonsillectomy demonstrated a significantly lower incidence of obesity compared with matched non-surgical controls (7.9% vs 10.6%; HR 0.73, 95% CI 0.68–0.79; p < 0.001).
In contrast, during the early postoperative period, children undergoing tonsillectomy exhibited increased weight gain within the first 6 months, with a higher incidence of obesity relative to non-surgical controls (12.4% vs 10.1%; HR 1.18, 95% CI 1.08–1.29; p < 0.001).

Conclusions: Tonsillectomy in pediatric patients was associated with a transient increase in postoperative weight gain during the early follow-up period, followed by a significantly lower incidence of obesity at 24 months compared with non-surgical management. These findings suggest that while short-term weight gain may occur after tonsillectomy, the long-term risk of obesity appears reduced. Further prospective studies are warranted to elucidate underlying mechanisms and to better characterize the temporal relationship between tonsillectomy and weight outcomes in children.