BackgroundSevere obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are limited, while short-term outcomes of adolescent bariatric surgery are promising. This study aimed to report 5-year outcomes following Roux-en-Y gastric bypass (RYGB) in adolescents, compared with conservatively treated adolescents and adults undergoing RYGB.MethodsA nationwide prospective non-randomised controlled study of adolescents (13–18 years) with severe obesity undergoing RYGB, a matched adolescent control group undergoing conservative treatment, and an adult comparison group undergoing RYGB. The primary outcome measure was change in weight over 5 years. Multilevel mixed-effect regression models were used to assess longitudinal changes. Healthcare usage was analysed with linear regression together with nonparametric bootstrapping.FindingsEighty-one adolescents with baseline age 16·5 years (SD 1·2), weight 132·8 kg (SD 22·1) and body mass index (BMI) 45·5 kg/m2 (SD 6·1) underwent RYGB. Five-year weight change was −36·8 kg (95% CI −40·9 to −32·8) resulting in a BMI reduction of 13·1 kg/m2, although weight loss <10% occurred in 11%.Comorbidities and cardiovascular risk factors resolved in 74–100%: type 2 diabetes (3/3), disturbed glucose homeostasis (18/21), dyslipidaemia (43/52), elevated blood pressure (11/12), inflammation (hs-CRP ≥ 2 mg/L; 45/61) and elevated liver enzymes (19/19), each comparing favourably with adolescent controls at 5 years.Functional (SF-36) and obesity-specific (OP-14) quality of life improved in the adolescent RYGB group (mean difference 4·2, p=0·006 and −9·9 p=0·009). Twenty RYGB participants (25%) underwent additional abdominal surgery for complications of surgery or rapid weight loss, 72% demonstrated some nutritional deficiency, and healthcare consumption increased. Mean BMI increased in control adolescents (3·3 kg/m2, 95% CI 1·9 to 4·8), while BMI change in adults was similar to surgical adolescents (mean difference 0·8 kg/m2, 95% CI −1·1 to 2·8). Twenty adolescent controls (25%) underwent bariatric surgery within 5 years.InterpretationAdolescents with severe obesity undergoing RYGB experienced substantial weight loss over 5 years, alongside improvements in comorbidities, risk factors and quality of life. Surgical intervention was, however, associated with additional surgical interventions and nutritional deficiencies. Non-surgical treatment was associated with weight gain and 25% underwent bariatric surgery within 5 years.

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CONTEXT: The prevalence of obesity among adolescents has increased and we lack effective treatments. OBJECTIVE: To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care. DESIGN, SETTING AND PATIENTS: Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m À 2 undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n ¼ 81) and an adolescent group (n ¼ 81) receiving conventional care. MAIN OUTCOME MEASUREMENTS: Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group. RESULTS: Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5 ± 6.1 (mean ± s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (Po0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (420 mU l À 1 ) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients. CONCLUSIONS: Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.International Journal of Obesity (2012Obesity ( ) 36, 1388Obesity ( -1395 doi:10.1038/ijo.2012; published online 25 September 2012Keywords: adolescent; bariatric; surgery; gastric bypass INTRODUCTIONThe health consequences for adolescents with obesity are serious. There is an increased risk of cardiovascular and endocrine disorders, metabolic syndrome, various cancers and psychosocial problems. [1][2][3] Taken together, quality of life and life expectancy are reduced. 4 Yet behavioral intervention constitutes the cornerstone of childhood and adolescent obesity treatment, 3 the results for adolescents are modest. 5 Among severely obese adolescents, favorable effects of non-surgical treatment seem to be very limited and clearly insufficient for long-term reduction of the health hazards associated with obesity. 6,7 Bariatric surgery in adults results in long-term weight loss, decrease in mortality and morbidity and improvements in quality of life. [8][9][10][11] However, surgery is not generally endorsed u...

In maximally vasodilated SHR and NCR kidneys, perfused with filtrable and non-filtrable perfusates, analyses have been performed concerning the extent of average renal tissue pressure (Pt) elevation which occurs upon glomerular filtration and causes passive autoregulation of flow. The results illustrate the great importance of distinguishing between 'apparent' (PA--PV/flow) and 'true' (PA--Pt/flow) renal resistance to flow. This is particularly so when the compared SHR and NCR renal vascular beds differ not only in true total renal resistance but also concerning the structurally determined ratio between the pre- and post-glomerular resistances. The combined results show that this ratio is considerably elevated in adults SHT kidneys because of structural vascular changes, which is perhaps the most efficient way of resetting the 'long term barostat function' of the kidneys in hypertension. It is also illustrated how the altered pre-/post-glomerular ratio in SHR in combination with Pt rises can so markedly distort the results of apparently precise in vitro comparisons of SHR and NCR renal vascular beds as to give entirely misleading results, with underestimations of the structurally based vascular hyperreactivity of the preglomerular section in SHR.