Family factors that characterize adolescents with severe obesity and their role in weight loss surgery outcomes

Abstract

Objective To comprehensively assess family characteristics of adolescents with severe obesity and whether family factors impact weight loss outcomes following weight loss surgery (WLS). Methods Multi-site prospective data from 138 adolescents undergoing WLS and primary caregivers (Adolescent Mage=16.9; MBMI= 51.5 kg/m2; Caregiver: Mage=44.5; 93% female) and 83 non-surgical comparators (NSComp: Adolescent: Mage=16.1; MBMI= 46.9 kg/m2; Caregiver: Mage=43.9; 94% female) were collected using standardized measures at pre-surgery/baseline, 1- and 2-years. Results The majority (77.3%) of caregivers were obese, with rates of caregiver WLS significantly higher in the WLS (23.8%) versus NSComp group (3.7%, p<.001). Family dysfunction was prevalent (≈1 in every 2–3 families), with rates higher for NSComp than the WLS group. For the WLS group, pre-operative family factors (i.e., caregiver BMI or WLS history, dysfunction, social support) were not significant predictors of adolescent weight loss at 1- and 2-years post-operatively, although change in family functioning over time emerged as a significant correlate of percent weight loss. Conclusions Rates of severe obesity in caregivers as well as family dysfunction were clinically noteworthy, although not related to adolescent weight loss success following WLS. However, change in family communication and emotional climate over time emerged as potential targets to optimize weight loss outcomes.

Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery

“…Factors previously found to predict attrition from adolescent behavioral weight management programs such as family stressors and maternal distress were not significant predictors in this study. A recent study found that family dysfunction was unrelated to weight loss outcomes in adolescents post-surgery [17] and suggested that, despite exhibiting clinically significant family dysfunction, some adolescents still completed surgery, which may explain the current findings. It is also possible that families reporting higher rates of communication problems and emotional conflict prior to surgery may opt out of the procedure due to added strain on the family.…”

“…The present paper also adds to an emerging literature highlighting the occurrence of bariatric surgery in multiple generations within a household [17, 28, 29]. The risks and benefits of caregiver bariatric surgery on adolescent patient bariatric surgery outcomes are unknown, although this is an anticipated area of investigation within the Teen-LABS consortium and associated ancillaries [30].…”

“…Skelton and Beech [18] acknowledged the importance of family/caregiver factors in understanding contributors to adolescent obesity program attrition, suggesting caregiver-related factors (i.e., family stressors and functioning) [19] be routinely examined [14, 16]. For example, recent literature demonstrates that aspects of family dysfunction and maternal distress are clinically significant in this population [17] and that adolescents being evaluated for surgery should be considered within a family context.…”

Weight Loss Surgery in Adolescents

“…Neither patient‐related preoperative features, including eating disorders and affective disorders, nor family‐related factors, such as caregiver weight status or family dysfunction, clearly contribute to poorer outcomes. However, adolescent perceptions of improved family communication and emotional climate are associated with improved weight loss 62 . When weight regain is a concern, behavioral support as well as food tracking may be useful in addressing these behaviors 33…”

Youth weight status and family functioning in paediatric primary care

“…Additionally, the samples from these 17 studies were drawn from diverse locations, including primary care, community settings, and paediatric weight management programs. Zeller et al also assessed family functioning among adolescents in weight management and adolescents receiving bariatric surgery, where approximately 32% of families met criteria for impaired family functioning based on the clinical cutoff score. In population‐level data, adolescents with healthier family functioning, assessed by the FAD, had healthier diet and physical activity behaviours and weight status .…”