Bariatric surgery in morbidly obese adolescents: A 4-year follow-up of ten patients

Widhalm, Kurt; Dietrich, Sabine; Prager, Gerhard; Silberhummer, G.; Orth, Denise; Kispal, Zoltan Farkas

doi:10.1080/17477160801897208

Cited by 19 publications

(21 citation statements)

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“…[19][20][21] The gastric bypass might be beneficial in adolescents with a risk of reduced compliance, as the weight loss is more consistent compared with after gastric banding. 11,22,23 The weight loss after gastric bypass has recently been demonstrated to be due to alterations in gastrointestinal and central neuroendocrine signaling causing reduced hunger, 24 augmented satiety, [25][26][27] possibly increased energy expenditure, 28 and altered taste perception and food preference. 29,30 A strong indication that physiological mechanisms determine weight loss after gastric bypass is that 93% of adolescents in our study achieved 450% excess weight loss despite a low number of outpatient visits, median 5 over 2 years compared with 20 visits in the O'Brien study.…”

Section: Discussionmentioning

confidence: 99%

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

et al. 2012

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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...

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Section: Discussionmentioning

confidence: 99%

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

et al. 2012

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“…Comprehensive studies of adolescent bariatric surgery outcomes are in their infancy and are critically needed. Six published studies to date have reported on the psychosocial outcomes of adolescent bariatric surgery, including impressive weight outcomes of RYGBP (18,19) and laparoscopic‐adjustable gastric banding (20) in the United States as well as positive outcomes of laparoscopic‐adjustable gastric banding in Austria (21) and Israel (22). However, many of these studies were based on retrospective chart reviews and were limited by small sample sizes or nonsystematic and/or significant loss to follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Functioning Improves Following Adolescent Bariatric Surgery

Zeller

Modi

Noll

et al. 2009

Obesity

123

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The aims of the present study were to examine changes in health‐related quality of life (HRQOL) and depressive symptoms in adolescents with extreme obesity undergoing Roux‐en‐Y gastric bypass (RYGBP) across the first postoperative year. A prospective longitudinal observational study of 31 adolescent patients undergoing RYGBP at a pediatric medical center (mean = 16.4 years; 64.5% females, mean BMI 63.5; 97% of study eligible and consecutive patients) was conducted. Participants completed two adolescent HRQOL measures, the PedsQL (generic) and the IWQOL‐Kids (weight‐related), the Beck Depression Inventory (BDI), and height and weight were measured at three time points: baseline, and 6 and 12 months following RYGBP. Prior to RYGBP, significant impairments in HRQOL were documented and 38.7% reported depressive symptomatology in the clinical range. As expected, BMI and depressive symptoms decreased and HRQOL improved from baseline to 12 months post‐RYGBP. Linear mixed modeling analyses detected several nonlinear slopes in BMI, depressive symptoms, and the majority of HRQOL domains over time with deceleration in these postoperative changes beginning at the 6th month time point. In contrast, the rate of change in weight‐related social relations was linear (e.g., no deceleration), indicating continued improvement across the first postoperative year. Adolescent RYGBP results in significant improvement in HRQOL and depressive symptomatology over the first postoperative year. Longer‐term follow‐up will be critical to determine adolescent weight and psychosocial trajectories, their interrelations, and what role psychosocial status plays in continued weight loss, maintenance, and regain.

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“…Only a few studies have investigated psychosocial effects of bariatric surgery and the results are short term and based on small patient series’ [49]. Some studies indicate significant rates of high depression scores and negative self-acceptance in adolescents after laparoscopic adjustable gastric banding (LAGB) [50]. When bariatric surgery does not work as expected, people can feel shame and guilt [51], further enhancing the burden of being obese.…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery for obese children and adolescents: a review of the moral challenges

Hofmann

2013

BMC Med Ethics

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BackgroundBariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process.DiscussionA wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.SummaryPerforming bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.

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Bariatric surgery in morbidly obese adolescents: A 4-year follow-up of ten patients

Abstract: The laparascopic gastric banding operation was not as effective in weight reduction as expected. We have to turn our attention to compliance, postoperative treatment and the psychological component.

Cited by 19 publications

References 7 publications

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

Psychosocial Functioning Improves Following Adolescent Bariatric Surgery

Bariatric surgery for obese children and adolescents: a review of the moral challenges

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