Obesity is a multifactorial disease of epidemic and global proportions that poses the most significant threat to the health of our younger generations. Those who are the most extremely affected bear the largest burden of health problems. In the US, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. Weight loss (bariatric) surgery has been advocated as an intervention for those with extreme obesity. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities, namely type 2 diabetes, dyslipidemias, hypertension and obstructive sleep apnea syndrome. A surge in weight loss operations for adolescents has been observed recently, with a threefold increase in case volumes nationwide from 2000 to 2003. Current evidence suggests that after bariatric surgery, adolescents lose significant weight and serious obesity-related medical conditions and psychosocial status are improved. Thus it is reasonable to propose that bariatric surgery performed in the adolescent period may be more effective treatment for childhood-onset extreme obesity than delaying surgery for extremely obese youth until adulthood. This position has been echoed by a number of groups and an independent systematic review. Finally, it is conceivable that bariatric surgery performed in adulthood for childhood onset extreme obesity may not be as effective for comorbidity treatment as surgery performed earlier during adolescence. The purpose of this review is to examine the evidence, which supports early rather than later use of bariatric surgery in the treatment of extreme obesity, and to present this information in light of the medical and surgical risks of bariatric surgery.

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Background Attending support groups connects adults undergoing bariatric surgery to peers and may improve weight loss efficacy. Predictors and outcomes of support group attendance of adolescents undergoing bariatric surgery are unknown. Objective The objective of this cohort study was to determine the rate, predictors, and outcomes of support group attendance in a free-standing adolescent bariatric program. Setting Academic children’s hospital in the U.S. Methods Charts of 68 consecutive adolescents who underwent laparoscopic Roux-en-y gastric bypass or vertical sleeve gastrectomy were retrospectively reviewed, recording demographic and anthropometric variables, support group, and clinic visit attendance. Prospectively collected vitamin adherence data were also analyzed. Univariate analyses evaluated characteristics and multivariate analyses evaluated predictors of support group attendance, clinic visit, and vitamin adherence. Results Of the 68 subjects, one third attended 1–3 support sessions, one third attended ≥4, and one third were non-attenders. Greater distance from clinical center (p=0.01) and caregiver bariatric history (p=0.05) were associated with decreased attendance. Only high pre-operative body mass index (BMI) (p < 0.01) and caregiver bariatric history (p < 0.01) were independently associated with decreased attendance. Increased attendance was associated with higher 6 (p=0.03) and 12 month (p<0.01) clinic visit attendance but not with multi-vitamin adherence (p=0.33). Conclusions Caregiver bariatric history and higher pre-operative BMI were associated with decreasing attendance at an adolescent bariatric support group program. This highlights a need to encourage attendance in these patients since adolescent attendance at support group sessions was positively associated with greater adherence to scheduled clinic visits post-operatively which may positively influence long-term outcomes.

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Objectives The primary aim of this cross-sectional study was to determine if the physical home food environment (availability of foods and beverages in the home) differed by maternal weight status using an open home food inventory. Methods Each weight status group (normal weight, overweight, obese, post-bariatric surgery) included eight mothers for a total of 32 mothers (41.5 ± 5.7 years old, 65.6% white) with a child 6–12 years old (9.2 ± 2.3 years old, 65.6% white). An open home food inventory was conducted by research personnel to record all food and beverage items in each home food environment. The item name/brand, size, and quantity was recorded. For each household, all items were entered into Nutrition Data Systems for Research (NDS-R) to determine total energy (kcals) and servings of fruits, vegetables, sugar-sweetened beverages (SSBs), and snacks available in the home. Descriptive statistics were used to analyze demographic characteristics between groups. A one-way ANOVA was used to analyze differences between groups for the following dependent variables: calories, servings of fruits, servings of vegetables, servings of snacks, and servings of SSBs. If there were significant differences post-hoc analyses were conducted. Results Households had an average of 4.5 ± 1.4 members, and the majority (40.6%) reported an annual income of $100,000 or more. There was a significant difference for SSBs (F (3,28) = 4.06; P = 0.016) in the home food environment with mothers in the post-bariatric group having significantly fewer servings of SSBs available in the home compared to mothers in the obese group (post-bariatric: 35.3 ± 37.3 servings; obese: 158.5 ± 105.7 servings; P = 0.013 ). Total energy (P = 0.27), servings of fruit (P = 0.11), servings of vegetables (0.17), and servings of snacks (P = 0.42) did not significantly differ between households. Conclusions Given the recommendation to eliminate SSBs following bariatric surgery these data support that this change is being made within the home food environment of mothers who received bariatric surgery as compared to mothers with obesity. Limited differences between physical home food environments may warrant consideration of additional environmental and behavioral factors associated with weight outcomes. Funding Sources S. Robson start-up funds (University of Delaware); I. Kahete was supported by The Delaware INBRE program.

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