A multidisciplinary approach to the adolescent bariatric surgical patient

Inge, Thomas H.; Garcia, Victor F.; Daniels, Steven R.; Langford, Linda; Kirk, Shelley; Roehrig, Helmut R.; Amin, Raouf S.; Zeller, Meg H.; Higa, Kelvin

doi:10.1016/j.jpedsurg.2003.11.025

Cited by 172 publications

(106 citation statements)

References 37 publications

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“…With limited to no evidence available, experts agree that surgical approaches should be considered only for adolescents with extreme morbid obesity, and pharmacologic approaches should be limited to a second-tier approach after failed behavioral counseling. 111,121 In contrast, current data suggest that a substantial proportion of children under age 12 or 13, even with BMIs of Ͼ95th percentile, will not develop adult obesity. Children 8 to 12 years of age have been the most well studied for behavioral overweight treatment, but we still have very limited information about interventions that would be applicable to primary care.…”

Section: E138mentioning

confidence: 72%

“…We attempted to estimate the rate of harms from the uncontrolled cohort literature, but loss to follow-up monitoring (25-60% at 4 -24 months) [111][112][113] and inadequate reporting prevented us from making reasonable estimates of surgery-associated harms. Table 6 summarizes the overall quality of evidence, according to USPSTF criteria, 35 for each key question addressed in this review (see Appendix).…”

Section: Surgerymentioning

confidence: 99%

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Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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ABSTRACT. Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is >50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.Conclusions.

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Section: E138mentioning

confidence: 72%

Section: Surgerymentioning

confidence: 99%

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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“…There are a number of small reports of comparable outcomes in adolescents (e.g., Inge et al 2004a;Sugerman et al 2003). Weight loss following bariatric surgery is associated with significant improvements in obesity-related co-morbidities in adults and adolescents.…”

Section: Postoperative Outcomesmentioning

confidence: 99%

Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

Sarwer

Dilks

2011

J Youth Adolescence

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The prevalence of childhood and adolescent obesity has tripled in the past three decades. This increase has been accompanied by a dramatic rise in obesity-related health complications among American youth. Thus, many obese youth are now experiencing illnesses that will threaten their life expectancy in the absence of significant weight loss. Despite these concerns, a relatively modest body of research has focused on the treatment of adolescent obesity. Results from trials investigating the efficacy of behavioral and pharmacological treatments, like studies of these interventions with adults, suggest that individuals typically lose 5-10% of their initial weight.

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“…Prior attempts at weight loss through behavior or dietary changes must be well documented. Multidisciplinary evaluation by pediatric specialists is advised to ensure that the patient and family understand the risks and benefits and meet selection criteria [11]. Guidelines based on strict BMI cut-point of 40 or 50 kg/m 2 may however eventually be replaced by BMI guidelines based on the 99th percentile for BMI, as this may be a more precise cut-point to identify extremely obese teens with high likelihood of having significant cardiovascular and dysmetabolic risk factors, as well as persistence of extreme obesity into adulthood [4,12].…”

Section: Indicationsmentioning

confidence: 99%

Bariatric surgery for extreme adolescent obesity: Indications, outcomes, and physiologic effects on the gut–brain axis

Xanthakos

2008

Pathophysiology

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Objective-This review will summarize current indications, limitations and outcomes of bariatric surgery in adolescents, as well as provide an overview of the physiologic effects of bariatric surgery on enteric hormones involved in regulating appetite, satiation and maintenance of weight.Results-Extreme obesity (BMI ≥ 99 percentile) now affects 4% of children and adolescents in the United States. Traditional dietary and behavioral weight management methods have no demonstrated efficacy for extremely obese children and adolescents, in contrast with bariatric surgery which has produced significant and sustainable weight loss and associated improvements in comorbid diseases for the extremely obese. Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed bariatric surgical procedures in adolescents, but vertical sleeve gastrectomy may be a promising new option for selected extremely obese adolescents. A mean weight loss of 37-40% is achieved in adolescents after RYGB, with LAGB showing similar results, albeit attained at a slower rate.Conclusion-Alterations in the enteric hormones involved in the gut-brain axis that regulates appetite and energy expenditure may play a role in both the anorexigenic and weight-reducing effects of certain bariatric surgical procedures. In particular, RYGB induces a rise in both fasting and post-prandial peptide tyrosine-tyrosine which could contribute to the more rapid and greater degree of weight loss than is seen with LAGB. Limitations of bariatric surgery however include the potential for post-operative morbidity and mortality, as well as possible weight regain in a small proportion of patients.

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A multidisciplinary approach to the adolescent bariatric surgical patient

Cited by 172 publications

References 37 publications

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

Bariatric surgery for extreme adolescent obesity: Indications, outcomes, and physiologic effects on the gut–brain axis

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