Baseline BMI is a Strong Predictor of Nadir BMI after Adolescent Gastric Bypass

Abstract

Objective-Surgical treatment of extreme obesity may be appropriate for some adolescents. We hypothesized that surgical weight loss outcomes may differ by preoperative level of extreme obesity (body mass index [BMI] ≥99th percentile).Study design-A longitudinal assessment of clinical characteristics from 61 adolescents who underwent laparoscopic Roux-en-Y gastric bypass at a single pediatric center from 2002 until 2007 was performed. Patients were categorized into 1 of 3 preoperative BMI groups: group 1, BMI = 40.0 to 54.9 (n = 23); group 2, BMI = 55.0 to 64.9 (n = 21); group 3, BMI = 65.0 to 95.0 (n = 17). Changes in BMI and cardiovascular risk factors between baseline and year 1 were evaluated using repeatedmeasures mixed linear modeling.Results-BMI in the overall cohort at baseline (60.2 ± 11 kg/m 2 ) decreased by 37.4% at 1 year after surgery (P < .001). Percent BMI change varied little by preoperative BMI groups (−37.2%, −36.8%, and −37.7% for groups 1, 2, and 3 respectively; P = .8762). The rate of change in absolute BMI units significantly varied by preoperative BMI class (group × time interaction, P < .0001), with 1-year nadir BMI values for groups 1, 2, and 3 falling to 31 ± 4 kg/m 2 , 38 ± 5 kg/m 2 , and 47 ± 9 kg/ m 2 , respectively. One year after surgery, only 17% of patients achieved a nonobese BMI (<30 kg/ m 2 ). Significant improvements in systolic and diastolic blood pressure (P < .0001), fasting insulin (P < .0001), total cholesterol (P = .0007), and triglyceride levels (P < .0001) were seen after surgery irrespective of baseline BMI class. Mean albumin levels remained normal despite significant caloric restriction and weight loss.Conclusions-Laparoscopic gastric bypass resulted in improvement or reversal of cardiovascular risk factors and resulted in a decrease in BMI of approximately 37% in all patients, regardless of starting BMI, 1 year after surgery. The timing of surgery for adolescent extreme obesity is an important consideration, because "late" referral for bariatric surgery at the highest of BMI values may preclude reversal of obesity.Pediatric obesity is recognized as one of the most significant public health issues in the United States. cardiopulmonary disease, and the metabolic syndrome. In addition, numerous orthopedic, neurological, and gastroenterological conditions threaten the health of adolescents affected by excess weight. 3-8 Increasingly, weight loss surgery is being performed in extremely obese adolescents to effectively treat these comorbidities. 9 Early results from a retrospective study of outcomes in adolescents undergoing bariatric surgery suggest that health and weight loss outcomes will be similar if not better than results seen in adults. 10 The BMI spectrum for adolescents seeking surgery is broad, with values in the literature ranging from 35 to 95 kg/m 2 , with average BMI values much higher than those seen in most adult surgical practices. However, to date, no analysis has been done that examines adolescent surgical outcomes stratified by baseline BMI. E...

The Santoro III Massive Enterectomy: How Can We Justify the Risks in Obese Adolescents?

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Should bariatric surgery be performed in adolescents?

“…Furthermore, delaying surgical treatment influences not only the T2DM remission rate but also the outcome in respect to weight status. As Inge and coworkers have previously shown (95), the trough of BMI loss after RYGB is around 37% regardless of baseline BMI. Again, this raises the question of whether bariatric surgery should be offered before extreme BMI values (e.g.…”

Tidak ada korelasi antara asupan karbohidrat sederhana, lemak jenuh, dan tingkat aktivitas fisik dengan status gizi pada remaja dengan kegemukan dan obesitas

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