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Karasko D. A systematic review and meta-analysis combining adolescent and adult data to evaluate weight loss and the effect of age following the laparoscopic sleeve gastrectomy. Obes Rev 2024; 25:e13770. [PMID: 38804033 DOI: 10.1111/obr.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 03/05/2024] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
Obesity is a grave concern within the United States, resulting in lost productivity, increased medical costs, and comorbidities with lifelong repercussions. The laparoscopic sleeve gastrectomy is a treatment option for obesity. The following meta-analysis sought to combine adolescent and adult literature to determine the overall effect of the sleeve gastrectomy on weight loss, to evaluate the effect of age at the time of surgery on weight loss, and to describe and explore variation in weight loss by sample characteristics. Overall weight loss was assessed at proximal and distal points, a dichotomous moderator variable analysis was conducted with subjects ≤21 years of age and >21 years of age, and a meta-regression assessing % male, % female, and baseline BMI was conducted to assess moderator variables. The laparoscopic sleeve gastrectomy was effective at facilitating weight loss with effect sizes varying from 0.916 to2.816. Age, biological sex, and baseline BMI were not found to have an impact on weight loss. The clinical consequences of prolonged obesity are evident and earlier intervention may be justified to counter the long-term effects caused by obesity related comorbidities. Standardized reporting of comorbidities and the effect of bariatric surgery on comorbid conditions is essential to allow further analysis.
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Affiliation(s)
- Danielle Karasko
- University of Missouri, Columbia, Missouri, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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White GE, Boles RE, Courcoulas AP, Inge TH, Yanovski SZ, Jenkins TM, Zeller MH. Predictors of Alcohol Use, Alcohol-Related Problems, and Substance Use Following Adolescent Metabolic and Bariatric Surgery. ANNALS OF SURGERY OPEN 2024; 5:e461. [PMID: 39310362 PMCID: PMC11415110 DOI: 10.1097/as9.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 09/25/2024] Open
Abstract
Objective To identify factors associated with incident alcohol consumption, hazardous drinking, alcohol-related problems, and substance use up to 8 years following metabolic and bariatric surgery (MBS) during adolescence. Background In this cohort, nearly half of those who underwent MBS as adolescents screened positive for alcohol use disorder, symptoms of alcohol-related harm, or alcohol-related problems within 8 years post-surgery. Moreover, persistent or heavy marijuana use following MBS during adolescence is higher than national data. Methods This study includes 217 adolescents (aged 13-19 years) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy between 2007 and 2011 and were followed for up to 8 years. Participants self-reported alcohol use via the Alcohol Use Disorders Identification Test and substance use for up to 8 years. Results Female sex, pre-surgery lower body mass index, and pre-surgery substance use were independently associated with increased risk of incident post-surgery hazardous drinking. Pre-surgery psychiatric counseling was significantly associated with increased risk for new-onset substance use post-surgery. Starting substance use post-surgery or continuing pre- to post-surgery was independently associated with a higher risk of post-surgery hazardous drinking. Greater percent weight loss, starting post-surgery or continuing pre- to post-surgery psychiatric counseling, using alcohol, and hazardous drinking were independently associated with a higher risk of post-surgery substance use. Conclusions Future research with a nonsurgical control group should be examined to further elucidate the relationships between MBS and alcohol and substance use following surgery during adolescence.
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Affiliation(s)
- Gretchen E. White
- From the University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | | | - Thomas H. Inge
- Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Susan Z. Yanovski
- Division of Digestive Diseases and Nutrition, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Meg H. Zeller
- University of Cincinnati College of Medicine, Cincinnati, OH
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Shah SA, Khan NA, Qureshi FG. Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes. Curr Obes Rep 2024; 13:77-86. [PMID: 38172474 DOI: 10.1007/s13679-023-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children. RECENT FINDINGS MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.
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Affiliation(s)
| | - Noor A Khan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Mercy Hospital, Pittsburgh, PA, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and, Children's Medical Center Dallas, 1935 Medical District Drive, D2000, Dallas, TX, 75235, USA.
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Brandt S, Lennerz BS, Wiegand S, Schirmer M, Kleger P, Weyhreter H, Holle R, Hüttl TP, Dietl O, von Schnurbein J, Holl RW, Wabitsch M. Twelve-Month Outcomes after Metabolic and Bariatric Surgery among Youths Participating in a Structured Preparation and Follow-Up Program: Results of the Youth with Extreme Obesity Study. Obes Facts 2023; 17:59-71. [PMID: 38081152 PMCID: PMC10836940 DOI: 10.1159/000535104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/19/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION While invasive and associated with risks, metabolic and bariatric surgery (MBS) can promote sustained weight loss and substantial health benefits in youths with extreme obesity. The path toward informed decision making for or against MBS is poorly characterized and postoperative follow-up to assess risks and benefits is inconsistent. In youths with extreme obesity, we aimed to evaluate decision making toward MBS, as well as MBS outcomes and adherence with follow-up and recommendations in the setting of a structured pre- and post-MBS program. METHODS Participants were recruited in the setting of the multicenter "Youth with Extreme Obesity Study" (YES). YES is a cohort study in adolescents and young adults aged 14-24 years with obesity (BMI ≥30.0 kg/m2) who were recruited at four medical centers and one job center in Germany between 2012 and 2018. Participants at two medical centers with BMI ≥35 kg/m2, aged 14-24 years, and interested in pursuing MBS were included in the subproject 3 "Safety and effectiveness of weight loss surgery in adolescents with severe obesity within a structured pre- and post-surgery treatment program - an observational study" that comprised a 2-months pre- and 12-months post-MBS program. RESULTS Twenty-eight of 169 youths (17%) with BMI ≥35 kg/m2 were interested in MBS. Twenty-six fulfilled published eligibility criteria for MBS and participated in the structured pre-MBS preparation program. Of these, 9 participants (2 females) decided against, and 17 (n = 11 females) decided for MBS (sleeve gastrectomy). The 12-month follow-up rate was high (16/17 [94%]) and all participants achieved significant weight reduction (ΔBMI: -16.1 ± 5.6 kg/m2). Eleven of 16 participants (69%) reported taking the prescribed dietary supplements in the first year after MBS, but only five of them (31%) did so daily. In contrast to the high 12-month retention rate, follow-up after completion of the structured program was low at 24-months (9/16 [56%]) and at 36-months (5/15 [36%]), respectively. CONCLUSION Participants demonstrated active decision making for or against MBS and high adherence with the structured pre- and 12 months post-MBS program, but participation was low thereafter. These findings endorse the need for longer term structured post-MBS programs to capture long-term outcomes and provide adequate care in this vulnerable group at the transition to adulthood.
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Affiliation(s)
- Stephanie Brandt
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany,
| | - Belinda S Lennerz
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Wiegand
- Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melanie Schirmer
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Pauline Kleger
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Helmut Weyhreter
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Rolf Holle
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas P Hüttl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Otto Dietl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Julia von Schnurbein
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Wabitsch
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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White GE, Boles RE, Courcoulas AP, Yanovski SZ, Zeller MH, Jenkins TM, Inge TH. A Prospective Cohort of Alcohol Use and Alcohol-related Problems Before and After Metabolic and Bariatric Surgery in Adolescents. Ann Surg 2023; 278:e519-e525. [PMID: 36538630 PMCID: PMC10188659 DOI: 10.1097/sla.0000000000005759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe alcohol use, alcohol-related harm, and alcohol-related problems preoperatively and up to 8 years following metabolic and bariatric surgery (MBS) in adolescents. BACKGROUND Risk for alcohol use and alcohol use disorders (AUD) increases post-Roux-en-Y gastric bypass and vertical sleeve gastrectomy in adults. However, data are lacking in adolescents who undergo MBS. METHODS This study includes 217 adolescents (aged 13-19 y) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy (2007-2011) and reported alcohol use preoperatively and annually postoperatively for up to 8 years. Time to elevated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score, alcohol-related harm, and alcohol-related problems were analyzed with Kaplan-Meier estimates of cumulative incidence. RESULTS Preoperatively, the median age was 17 years; the median body mass index was 51 kg/m 2 . Alcohol use frequency and average quantity of drinks per drinking day increased postoperatively (2% consumed alcohol 2-4 times/month 6 months versus 24% 8 years postoperatively, P <0.001; 2% consumed≥3 drinks per drinking day 6 months versus 35% 8 years postoperatively, P <0.001). Cumulative incidence of postoperative onset elevated AUDIT-C score, alcohol-related harm, and alcohol-related problems at year 8 were 45% (95% CI:37-53), 43% (95% CI:36-51), and 47% (95% CI:40-55), respectively. CONCLUSIONS Nearly half of those who underwent MBS as adolescents screened positively for AUD, symptoms of alcohol-related harm, or alcohol-related problems 8 years post-MBS, highlighting the risk for alcohol use and AUD after MBS in adolescents. AUD evaluation and treatment should be integrated into routine long-term care for adolescents undergoing MBS.
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Affiliation(s)
| | | | | | - Susan Z Yanovski
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD
| | - Meg H Zeller
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas H Inge
- Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
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Burghard AC, Rahming VL, Sonnett Fisher A, Zitsman JL, Oberfield SE, Fennoy I. The Relationship between Metabolic Comorbidities and Post-Surgical Weight Loss Outcomes in Adolescents Undergoing Laparoscopic Sleeve Gastrectomy. Horm Res Paediatr 2023; 97:261-269. [PMID: 37356432 DOI: 10.1159/000531655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/16/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION Little is known about the relationship between metabolic factors and weight loss success in adolescents undergoing bariatric surgery. METHODS The objective of this study was to assess if baseline metabolic characteristics associate with weight loss in adolescents undergoing laparoscopic sleeve gastrectomy. A retrospective study was conducted in a comprehensive adolescent bariatric surgery center of 151 subjects (34 male, 117 female). Anthropometric measurements and metabolic factors including blood pressure, fasting glucose, hemoglobin A1c (HbA1c), metabolic syndrome (MeS), liver function, triglycerides, and waist circumference were collected at one pre-surgical visit and at 6- and/or 12-month post-laparoscopic sleeve gastrectomy. Weight loss was compared between subjects with normal or abnormal baseline metabolic factors. Absolute BMI change was used to measure successful weight loss. RESULTS Higher baseline systolic blood pressure (SBP) was associated with greater weight loss as measured by body mass index (BMI) change and BMI standard deviation score (BMI-SDS) change at 6 and 12 months. Those patients in the 6-month follow-up group with an abnormal HbA1c at baseline had significantly more weight loss as measured by BMI-SDS. None of the other parameters, including fasting glucose, MeS, liver function, triglycerides, and waist circumference showed a predictive relationship. CONCLUSION Elevated SBP and HbA1c in adolescents with morbid obesity may reflect a population more likely to achieve successful weight loss and, thus, may be a good target for bariatric surgery, specifically laparoscopic sleeve gastrectomy, as an intervention for severe obesity. An assessment of behavioral differences in patients with and without elevated BP and HbA1c might explain the mechanism for the improved weight loss.
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Affiliation(s)
- Anne Claire Burghard
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York, USA
| | - Virginia L Rahming
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York, USA,
| | - Anna Sonnett Fisher
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey L Zitsman
- Center for Adolescent Bariatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York, USA
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York, USA
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S.V M, Nitin K, Sambit D, Nishant R, Sanjay K. ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity In India. Indian J Endocrinol Metab 2022; 26:295-318. [PMID: 36185955 PMCID: PMC9519829 DOI: 10.4103/2230-8210.356236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Madhu S.V
- Department of Endocrinology, Centre for Diabetes, Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Kapoor Nitin
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Das Sambit
- Department of Endocrinology, Hi Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - Raizada Nishant
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Kalra Sanjay
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Bouchard ME, Tian Y, Linton S, De Boer C, O'Connor A, Ghomrawi H, Abdullah F. Utilization Trends and Disparities in Adolescent Bariatric Surgery in the United States 2009-2017. Child Obes 2022; 18:188-196. [PMID: 34647817 DOI: 10.1089/chi.2021.0201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Current reports of adolescent bariatric surgery underutilization for treating severe obesity do not comprehensively assess the extent of existing disparities. We sought to describe national trends in adolescent bariatric surgery over a 9-year period and investigate previously described ethnoracial-, insurance-, income-, and geographic-based disparities. Methods: A cross-sectional analysis of adolescents aged 10-19 years who underwent bariatric surgery from 2009 to 2017 was conducted using Healthcare Cost and Utilization Kids' Inpatient Database and National Inpatient Sample Databases. Annual rates and types of bariatric surgery were assessed using trend analysis and stratified by patient, hospital, and regional characteristics. Results: The rate of bariatric surgeries per 1,000,000 adolescents with severe obesity increased over time (227 cases in 2009 to 331cases in 2017). Roux-en-Y gastric bypass and gastric band significantly decreased (p < 0.001), while sleeve gastrectomy became the most commonly performed bariatric surgery (p < 0.001). Surgeries were increasingly performed in urban teaching hospitals (77.9%) and most commonly in the Northeast (34.4%) and South (40.9%). The proportion of black patients (12.1%-15.8%) undergoing bariatric surgery increased, although was not significant and remained below that of white patients (p = 0.06). The proportion of publicly insured patients undergoing bariatric surgery significantly increased (17.0% to 30.7%, p < 0.001), although no changes were observed based on median household income. Conclusions: Over the study period, utilization of adolescent bariatric surgery has increased. Yet, vulnerable populations, who have the highest rates of severe obesity, continue to undergo bariatric surgery at disproportionately lower rates. Further efforts to address disparities and barriers to care are urgently needed to care for these children.
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Affiliation(s)
- Megan E Bouchard
- Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Yao Tian
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samuel Linton
- Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christopher De Boer
- Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ann O'Connor
- Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Hassan Ghomrawi
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fizan Abdullah
- Department of Surgery, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Knighton BJ, Yusuf CT, Ha M, Ngaage LM, Gebran S, Kubicki N, Kligman MD, Rasko YM. Insurance Coverage of Pediatric Bariatric Surgery: a Cross-Sectional Analysis of the USA. Obes Surg 2022; 32:123-132. [PMID: 34687410 DOI: 10.1007/s11695-021-05744-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Pediatric bariatric surgery is increasingly recognized as a safe and effective option for the management of obesity and obesity-related conditions. However, insurance coverage is a key barrier to accessing these procedures. Criteria are variable and often not evidence-based. In an effort to characterize common patterns in insurance coverage, we report coverage criteria for adolescents relative to adults. MATERIALS AND METHODS We surveyed medical policies of the 50 highest market share health insurance providers in the USA. Private insurer coverage criteria included age, Tanner staging, skeletal maturity, body mass index, procedures covered, medical weight management requirements, co-morbidities, and multidisciplinary team criteria. These were then compared to the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. RESULTS Two thirds (n = 33, 66%) of companies provided inclusion criteria for adolescents. All policies covered RYGB (n = 33), most covered sleeve gastrectomy (n = 32, 97.0%). Obstructive sleep apnea (OSA) (n = 32, 97%), hypertension (HTN) (n = 27, 81.8%), and gastroesophageal reflux disease (GERD) (n = 11, 33.3%) were the three most commonly cited co-morbidities used as inclusion criteria. Tanner staging or skeletal maturity were most commonly used (n = 10, 30.3%). Similarly, twenty (60.6%) insurers required medical weight management programs. Multi-disciplinary teams were required by 81.8% of adolescent policies (n = 27) as described by the ASMBS. Seventeen (51.5%) policies defined providers for these teams, and 10 (30.3%) provided other defined criteria. CONCLUSION Contrary to ASMBS guidelines, companies commonly require Tanner staging and/or skeletal maturity criteria as well as participation in medical weight management programs. Also, multi-disciplinary team are frequently required but not well defined.
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Affiliation(s)
| | - Cynthia T Yusuf
- University of Maryland School of Medicine, Baltimore, 21201, USA
| | - Michael Ha
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
- Division of Plastic Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, 21205, USA
| | - Selim Gebran
- Division of Plastic Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, 21205, USA
| | - Natalia Kubicki
- Department of Surgery, University of Maryland Medical Center, Baltimore, 21201, USA
| | - Mark D Kligman
- Department of Surgery, University of Maryland Medical Center, Baltimore, 21201, USA
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA.
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Ogle SB, Ressalam J, Baugh CM, Campbell EG, Kelsey MM, Inge TH. Referral and utilization of paediatric bariatric surgery in an academic freestanding children's hospital with dedicated paediatric bariatric programme. Pediatr Obes 2021; 16:e12830. [PMID: 34296818 DOI: 10.1111/ijpo.12830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This report estimates the percent of medically eligible adolescents who are referred for metabolic and bariatric surgery (MBS) evaluation or factors associated with referral. METHODS This cross-sectional retrospective review evaluated patients aged 13 to 18 years seen between 2017 and 2019 for demographics, insurance status, body mass index (BMI), obesity-related comorbidities, and compared these data to patients whom had been referred and received MBS. RESULTS Half of the patients (86 411/163137, 53%) between ages of 13 and 18 years identified had BMI documented, of which, 1974 (2.3%) were medically eligible for MBS, 238 (12%) were referred for MBS and 52 (22%) underwent MBS. Females had similar odds of being eligible for MBS [odds ratio (OR) = 1.01, 95% confidence interval (CI) 0.92-1.11, P = .9], but greater odds of referral (OR = 1.58, 95% CI 1.13-2.23, P = .009). Independently, miniorities and patients with public insurance had higher odds of being eligible for MBS, but similar odds of being referred as non-Hispanic white patients. Black patients with public insurance had greater odds of being referred for MBS (OR = 12.22, 95% CI 2.08-235.15, P = .022). Patients' multiple comorbidities had greater odds of being referred for MBS (OR = 2.16, 95% CI 1.29-3.68, P = .004). CONCLUSIONS Referral is barrier for patients medically eligible for MBS; however, this barrier is not uniformly faced by all patients.
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Affiliation(s)
- Sarah B Ogle
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA.,Department of Surgery, University of Colorado, Denver, Colorado, USA
| | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Eric G Campbell
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Megan M Kelsey
- Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Thomas H Inge
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA.,Department of Surgery, University of Colorado, Denver, Colorado, USA
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All in the Family: Child and Adolescent Weight Loss Surgery in the Context of Parental Weight Loss Surgery. CHILDREN 2021; 8:children8110990. [PMID: 34828703 PMCID: PMC8620201 DOI: 10.3390/children8110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 12/05/2022]
Abstract
Background: Bariatric surgery is the most effective current treatment option for patients with severe obesity. More children and adolescents are having surgery, many whose parents have also had surgery. The current study examines whether parental surgery status moderates the association between perceived social support, emotional eating, food addiction and weight loss following surgery, with those whose parents have had surgery evidencing a stronger relationship between the psychosocial factors and weight loss as compared to their peers. Methods: Participants were 228 children and adolescents undergoing sleeve gastrectomy between 2014 and 2019 at one institution. Children and adolescents completed self-report measures of perceived family social support, emotional eating, and food addiction at their pre-surgical psychological evaluation. Change in body mass index (BMI) from pre-surgery to 3, 6, and 12 months post-surgery was assessed at follow-up clinic visits. Parents reported their surgical status as having had surgery or not. Results: There were no differences in perceived family support, emotional eating, or food addiction symptoms between those whose parents had bariatric surgery and those whose parents did not. There were some moderating effects of parent surgery status on the relationship between social support, emotional eating/food addiction, and weight loss following surgery. Specifically, at 3 months post-surgery, higher change in BMI was associated with lower perceived family support only in those whose parents had not had surgery. More pre-surgical food addiction symptoms were associated with greater weight loss at 3 months for those whose parents had not had surgery, whereas this finding was true only for those whose parents had surgery at 12 months post-surgery. Conclusions: Children and adolescents whose parents have had bariatric surgery may have unique associations of psychosocial factors and weight loss. More research is needed to determine mechanisms of these relationships.
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12
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Ogle SB, Dewberry LC, Jenkins TM, Inge TH, Kelsey M, Bruzoni M, Pratt JS. Outcomes of Bariatric Surgery in Older Versus Younger Adolescents. Pediatrics 2021; 147:peds.2020-024182. [PMID: 33526606 PMCID: PMC7919111 DOI: 10.1542/peds.2020-024182] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In this report, we compare weight loss, comorbidity resolution, nutritional abnormalities, and quality of life between younger and older adolescents after metabolic and bariatric surgery. METHODS From March 2007 to December 2011, 242 adolescents (≤19 years of age) who underwent bariatric surgery at 5 clinical centers in the United States were enrolled in the prospective, multicenter, long-term outcome study Teen-Longitudinal Assessment of Bariatric Surgery. Outcome data from younger (13-15 years; n = 66) and older (16-19 years; n = 162) study participants were compared. Outcomes included percent BMI change, comorbidity outcomes (hypertension, dyslipidemia, and type 2 diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery. RESULTS Baseline characteristics, except for age, between the 2 cohorts were similar. No significant differences in frequency of remission of hypertension (P = .84) or dyslipidemia (P = .74) were observed between age groups. Remission of type 2 diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; P = .046). Weight loss and quality of life were similar in the 2 age groups. Younger adolescents were less likely to develop elevated transferrin (prevalence ratio 0.52; P = .048) and low vitamin D levels (prevalence ratio 0.8; P = .034). CONCLUSIONS The differences in outcome of metabolic and bariatric surgery between younger and older adolescents were few. These data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone and that providers should consider adolescents of all ages for surgical therapy for obesity when clinically indicated.
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Affiliation(s)
- Sarah B. Ogle
- Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Lindel C. Dewberry
- Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Thomas H. Inge
- Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Megan Kelsey
- Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Matias Bruzoni
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California
| | - Janey S.A. Pratt
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California
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13
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Miravet-Jiménez S, Pérez-Unanua M, Alonso-Fernández M, Escobar-Lavado F, González-Mohino Loro B, Piera-Carbonell A. Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria. Semergen 2020; 46:415-424. [DOI: 10.1016/j.semerg.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
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14
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Ahn SM. Current Issues in Bariatric Surgery for Adolescents with Severe Obesity: Durability, Complications, and Timing of Intervention. J Obes Metab Syndr 2020; 29:4-11. [PMID: 32183507 PMCID: PMC7118002 DOI: 10.7570/jomes19073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Conventional nonsurgical management of severe obesity in the pediatric population and adolescents has focused on a multidisciplinary approach involving diet, exercise, behavioral modification, and to some extent, pharmaceuticals. Although nonsurgical strategies provide a certain degree of effective weight reduction, most of the severely obese adolescents suffer from a high relapse rate. In recent studies, long-term outcomes of bariatric surgery for severely obese adolescents have shown sustainable effects on weight loss and resolution of related comorbidities, such as hypertension and type 2 diabetes mellitus in this vulnerable age group. Notably, the role and practical benefits of bariatric surgery as a multidisciplinary therapeutic approach to adolescent obesity is gaining attention and acceptance. However, a surgical approach has many obstacles that prevent the timely evaluation and optimal intervention for adolescent obesity and its comorbidities. In the present review, the latest data on long-term outcomes after bariatric surgery for severely obese adolescents in terms of durability, effects on metabolic risk factors, complications, and optimal timing were summarized. The results showed the sustainability of weight loss and comorbidity resolution in adolescents following bariatric surgery. In addition, earlier surgery in patients without an extremely high body mass index increases the likelihood of a healthier life in adulthood. This review can help clarify the beneficial effects of bariatric surgery on weight reduction and resolution of comorbidities in severely obese adolescents and remove the barriers to referral of adolescents for bariatric surgery.
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Affiliation(s)
- Soo Min Ahn
- Department of Surgery, Bariatric and Metabolic Surgery Center, Pediatric Specialized Center, Hallym University Sacred Heart Hospital, Anyang, Korea
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15
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Bjornstad P, Nehus E, van Raalte D. Bariatric surgery and kidney disease outcomes in severely obese youth. Semin Pediatr Surg 2020; 29:150883. [PMID: 32238288 PMCID: PMC7125208 DOI: 10.1016/j.sempedsurg.2020.150883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bariatric surgery, an emerging treatment for severely obese youth with and without T2D, provides marked improvement in insulin resistance, beta-cell function, and central adiposity. Further, preliminary data suggest that bariatric surgery also results in significant improvement in markers of obesity-related nephropathy and DKD, beyond that which can be achieved with current medical interventions. Yet, the mechanisms whereby bariatric surgery attenuates kidney disease remain unclear. This review summarizes the data on the effects of bariatric surgery on obesity-related nephropathy and DKD in youth with and without T2D, in addition to potential mechanisms underlying the nephroprotective effects of weight loss surgery and how these may differ in Roux-en-Y gastric bypass vs. vertical sleeve gastrectomy. Finally, we discuss potential future non-surgical therapies to mitigate kidney disease.
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Affiliation(s)
- Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, United States.
| | - Edward Nehus
- Section of Nephrology, Department of Pediatrics, University of Cincinnati College of Medicine
| | - Daniel van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, location VUMC, Amsterdam, the Netherlands
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16
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Sarno LA, Lipshultz SE, Harmon C, De La Cruz-Munoz NF, Balakrishnan PL. Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review. Pediatr Res 2020; 87:202-209. [PMID: 31401646 DOI: 10.1038/s41390-019-0532-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022]
Abstract
The selection criteria, safety, and efficacy of bariatric surgery are well established in adults but are less well defined for severely obese adolescents. The number of severely obese adolescents who could benefit from weight loss surgery is increasing, although referral rates have plateaued. Surgical options for these adolescents are controversial and raise several questions. Recent studies, including the prospective Teen-Longitudinal Assessment of Bariatric Surgery Study and the Adolescent Morbid Obesity Surgery Study, help answer these questions. Early bariatric surgical intervention improves body mass index but, more importantly, improves cardiovascular and metabolic co-morbidities of severe obesity. A review of the medical, psychosocial, and economic risks and benefits of bariatric surgery in severely obese adolescents is a step toward improving the management of a challenging and increasing population. We describe the current knowledge of eligibility criteria, preoperative evaluation, surgical options, outcomes, and referral barriers of adolescents for bariatric surgery.
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Affiliation(s)
- Lauren A Sarno
- Division of Pediatric Cardiology, East Carolina University, Brody School of Medicine, Greenville, NC, USA.
| | - Steven E Lipshultz
- Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Carroll Harmon
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Preetha L Balakrishnan
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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17
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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18
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Armstrong SC, Bolling CF, Michalsky MP, Reichard KW. Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices. Pediatrics 2019; 144:peds.2019-3223. [PMID: 31656225 DOI: 10.1542/peds.2019-3223] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today's children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence.
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Affiliation(s)
- Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Center for Childhood Obesity Research, and Duke Clinical Research Institute, Duke University, Durham, North Carolina;
| | - Christopher F Bolling
- Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marc P Michalsky
- Department of Pediatric Surgery, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; and
| | - Kirk W Reichard
- Division of Pediatric Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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19
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Bolling CF, Armstrong SC, Reichard KW, Michalsky MP. Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity. Pediatrics 2019; 144:peds.2019-3224. [PMID: 31656226 DOI: 10.1542/peds.2019-3224] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an "epidemic within an epidemic" that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist.
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Affiliation(s)
- Christopher F Bolling
- Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Center for Childhood Obesity Research, and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Kirk W Reichard
- Division of Pediatric Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | - Marc P Michalsky
- Department of Pediatric Surgery, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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20
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Sartoretto A, Sui Z, Hill C, Dunlap M, Rivera AR, Khashab MA, Kalloo AN, Fayad L, Cheskin LJ, Marinos G, Wilson E, Kumbhari V. Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study. Obes Surg 2019; 28:1812-1821. [PMID: 29450845 DOI: 10.1007/s11695-018-3135-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success. DESIGN Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events. RESULTS In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed. CONCLUSIONS ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.
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Affiliation(s)
| | - Zhixian Sui
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Christine Hill
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Margo Dunlap
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Angielyn R Rivera
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - George Marinos
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Erik Wilson
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA.
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21
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Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 2019; 8:201-209. [PMID: 31054014 DOI: 10.1007/s13679-019-00347-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA.
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Megan M Oberle
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
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22
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Lee Y, Dang JT, Switzer N, Malhan R, Birch DW, Karmali S. Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m 2: a systematic review and meta-analysis. Surg Endosc 2019; 33:3578-3588. [PMID: 31399947 DOI: 10.1007/s00464-019-07027-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery on patients with body mass index (BMI) ≥ 50 kg/m2, historically known as superobesity, is technically challenging and carries a higher risk of complications. Bridging interventions have been introduced for weight loss before bariatric surgery in this population. This systematic review and meta-analysis aims to assess the efficacy and safety of bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2. METHODS MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to September 2018. Studies were eligible for inclusion if they conducted any bridging intervention for weight loss in patients with BMI greater than 50 kg/m2 prior to bariatric surgery. Primary outcome was the change in BMI before and after bridging intervention. Secondary outcomes included comorbidity status after bridging interventions and resulting complications. Pooled mean differences (MD) were calculated using random effects meta-analysis. RESULTS 13 studies including 550 patients met inclusion criteria (mean baseline BMI of 61.26 kg/m2). Bridging interventions included first-step laparoscopic sleeve gastrectomy (LSG), intragastric balloon (IGB), and liquid low-calorie diet program (LLCD). There was a reduction of BMI by 12.8 kg/m2 after a bridging intervention (MD 12.8, 95% CI 9.49-16.1, P < 0.0001). Specifically, LSG demonstrated a BMI reduction of 15.2 kg/m2 (95% CI 12.9-17.5, P < 0.0001) and preoperative LLCD by 9.8 kg/m2 (95% CI 9.82-15.4, P = 0.0006). IGB did not demonstrate significant weight loss prior to bariatric surgery. There was remission or improvement of type 2 diabetes, hypertension, and sleep apnea in 62.8%, 74.6%, and 74.6% of patients, respectively. CONCLUSIONS First-step LSG and LLCD are both safe and appropriate bridging interventions which can allow for effective weight loss prior to bariatric surgery in patients with BMI greater than 50 kg/m2.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jerry T Dang
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Noah Switzer
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Roshan Malhan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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23
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Chu L, Howell B, Steinberg A, Bar-Dayan A, Toulany A, Langer JC, Hamilton JK. Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24 months. Pediatr Obes 2019; 14:e12519. [PMID: 30843377 DOI: 10.1111/ijpo.12519] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Growing evidence supports the efficacy of paediatric bariatric surgery. However, there is a paucity of data examining adolescent outcomes post surgery. Among adults, studies have shown that early weight loss is associated with long-term weight loss. Therefore, the aim of our study was to investigate the association between early weight loss at 3 months with longer-term weight loss at 12 and 24 months in adolescents post surgery. We hypothesized that patients who have greater weight loss within the first 3 months will have greater weight loss at 12 and 24 months post surgery. METHODS A retrospective chart review of bariatric surgery patients (n = 28) was conducted. Anthropometric measurements at baseline and 3, 12, and 24 months were analysed. RESULTS Percent of excess weight loss (%EWL) at 3, 12, and 24 months were 33.6 ± 11.3%, 55.0 ± 20.5%, and 55.1 ± 27.1%, respectively. %EWL at 3 months was positively associated with %EWL at 12 and 24 months (P < 0.05). Receiver operating characteristic curve results identified a cut-off of greater than or equal to 30%EWL at 3 months predicted successful weight loss, defined as greater than or equal to 50%EWL at 12 and 24 months. CONCLUSION These findings demonstrate that majority of weight loss among adolescents occurs within the first postoperative year. Greater %EWL by 3 months post surgery predicts successful and sustained weight loss over time.
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Affiliation(s)
- Lisa Chu
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Brooke Howell
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada
| | - Alissa Steinberg
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada
| | - Alisa Bar-Dayan
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada
| | - Alene Toulany
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Jacob C Langer
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Jill K Hamilton
- SickKids Team Obesity Management Program, Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
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24
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Norain A, Arafat M, Burjonrappa S. Trending Weight Loss Patterns in Obese and Super Obese Adolescents: Does Laparoscopic Sleeve Gastrectomy Provide Equivalent Outcomes in both Groups? Obes Surg 2019; 29:2511-2516. [PMID: 31044352 DOI: 10.1007/s11695-019-03867-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many factors, including preoperative weight, may determine final weight loss after bariatric surgery; however, their proportional contribution is unclear. To such end, we evaluated weight loss patterns among obese adolescents. METHODS We evaluated 57 adolescents who underwent laparoscopic sleeve gastrectomy from 2011 to 2017. Data collection included demographics, anthropometrics, and comorbidities and was done over a 3-year follow-up period. Statistical analysis was performed using Student's t test and repeated measures ANOVA. RESULTS In the morbidly obese (MO) group, 82% were female, while 52% were male in the super obese (SMO) group (P < 0.0059). While 13/34 patients in the obese group achieved > 60% percent excess body weight loss (%EBWL), only 3/23 super obese patients achieved > 60% EBWL (P = 0.0695). %EBWL at 1-year follow-up significantly differed between the obese and super obese groups, 61.7 ± 14.6% and 47.7 ± 14.9% respectively (P = 0.035). The average BMI in the obese group was 29.8 at 1 year and 41.3 in the super obese group. There was a significant difference in the rate of excess weight loss (%EBWL/month) between the two groups (P < 0.01). There was good comorbidity resolution (about 70%) in both groups after surgery. CONCLUSION Comorbidity resolution after sleeve gastrectomy is excellent in the adolescent population irrespective of initial BMI. Consideration should be given to earlier bariatric intervention in SMO adolescents to facilitate return to near normal BMI. Focus on education of referral sources, such as community pediatricians and family practitioners to facilitate early bariatric evaluation should be considered. Weight loss in postsurgical SMO patients should be carefully monitored and adjunctive interventions should be considered.
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Affiliation(s)
- Abdullah Norain
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Mohammad Arafat
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Sathyaprasad Burjonrappa
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA. .,Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467-2401, USA. .,USF Health, Morsani College of Medicine, Tampa General Hospital, 1 Tampa General Circle, G 441, Tampa, FL, 33606, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the current state of surgical intervention for obesity in children and adolescents. Specifically, this review will discuss the different types of metabolic and bariatric surgery (MBS) procedures, guidelines for patient selection, and recent findings regarding surgical outcomes and complications. RECENT FINDINGS MBS is safe in adolescents and has also demonstrated sustainable long term weight loss and improvement in obesity-associated comorbidities. A recent prospective multi-institutional trial demonstrated BMI reductions of 3.8 kg/m2 (8%) to 15.1 kg/m2 (28%) after 3 years among adolescents undergoing the three most common MBS procedures. Moreover, MBS is associated with remission of type 2 diabetes, prediabetes, hypertension, dyslipidemia, and abnormal kidney function in 65-95% of patients in the study. Childhood and adolescent obesity is a continuing problem that has not been adequately addressed by the medical community. MBS is currently the most successful strategy for significant and sustained weight loss and improvement of associated comorbidities. This review focuses on the different types of MBS, the selection and preparation of patients for surgery, and the expected outcomes and common complications.
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Affiliation(s)
- Arunachalam Thenappan
- Division of Pediatric General and Thoracic Surgery, The George Washington University School of Medicine & Health Sciences, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Evan Nadler
- Division of Pediatric General and Thoracic Surgery, The George Washington University School of Medicine & Health Sciences, 111 Michigan Avenue NW, Washington, DC, 20010, USA
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Arafat M, Norain A, Burjonrappa S. Characterizing Bariatric Surgery Utilization and Complication Rates in the Adolescent Population. J Pediatr Surg 2019; 54:288-292. [PMID: 30522799 DOI: 10.1016/j.jpedsurg.2018.10.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Bariatric surgery is an increasingly common treatment of morbid obesity in the United States and has demonstrated effective weight loss and improvement of comorbidities. We used the National Surgical Quality Improvement Program (NSQIP) data to characterize bariatric surgery utilization and complication rates in the adolescent population. METHODS Demographics, surgical procedures, comorbidities, and 30-day outcomes of 2625 adolescents ages 18-21 who underwent bariatric surgery were analyzed from NSQIP data-bank from 2005 to 2015. RESULTS 79.5% of patients were females. Majority of patients identified as Caucasian or Black/African American (BAA) at 66.7% (73% of US population) and 15.5% (12.6% of US population), respectively. 15.9% identified as Hispanic. Comorbidities included diabetes in 9.3% (7.8% NIDDM), hypertension (9.5%), and dyspnea on moderate exertion (13.2%). Sleeve Gastrectomy, Laparoscopic Roux-En-Y (RY) and Adjustable Gastric Banding (AGB) were the three most common procedures performed during the study period. There has been a sharp trend towards SG in recent years (11.4% in 2010, to 66.6% in 2015), while RY utilization declined (47.4% in 2010 to 28.6% in 2015). Surgical complications were 2.4%, with the most common being superficial surgical site infection (0.7%), UTI (0.7%), and organ-space infection (0.4%). Reoperation and readmission rates within 30-days post-operation were 1.5% and 4.1%, respectively. Those with complications had longer length-of-stays (2.7 vs. 1.8 days, P < 0.001), greater reoperation rates (OR = 9.6, P < 0.001) and readmission rates (OR = 11.8, P < 0.001). CONCLUSION Morbid obesity is associated with significant comorbidity. SG is increasingly the most utilized form of bariatric surgery. While complications are low, they are associated with greater hospital length-of-stay, readmission, and reoperation rates. LEVEL OF EVIDENCE Treatment Study, Level III.
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Affiliation(s)
- Mohammod Arafat
- Department of Pediatric Surgery, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, NY
| | - Abdullah Norain
- Department of Pediatric Surgery, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, NY
| | - Sathyaprasad Burjonrappa
- Department of Pediatric Surgery, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, NY.
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Karasko D. Weight Loss in Adolescents After Bariatric Surgery: A Systematic Review. J Pediatr Health Care 2019; 33:26-34. [PMID: 30224297 DOI: 10.1016/j.pedhc.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/11/2018] [Accepted: 05/28/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Bariatric surgery is a treatment option for the obese adolescent. There are three primary surgical procedures: the bypass, sleeve gastrectomy, and lap band. The most recent literature was reviewed to examine changes in weight, comorbidities, and complications after bariatric surgery in the adolescent. METHOD A systematic search was performed to identify original research articles published in the United States between the years of 2000 and 2017 with patients between the ages of 11 and 21 years that provided greater than 30 days of results. RESULTS A total of 23 articles were identified. Weight loss, improvement in comorbidities, and complications after all procedures were reported. DISCUSSION Outcomes were not reported in a standardized fashion, creating much difficulty in interpreting and comparing results. The sleeve gastrectomy is increasing in incidence, whereas the lap band is decreasing. Further research is needed to draw more definitive conclusions regarding long-term results in the adolescent undergoing bariatric surgery.
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Affiliation(s)
- Danielle Karasko
- Danielle Karasko, Doctoral Candidate, University of Missouri, Columbia, MO, and Pediatric Nurse Practitioner, Children's Hospital of Philadelphia, Philadelphia, PA..
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28
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Fox CK, Kaizer AM, Ryder JR, Rudser KD, Kelly AS, Kumar S, Gross AC. Cardiometabolic risk factors in treatment-seeking youth versus population youth with obesity. Obes Sci Pract 2018; 4:207-215. [PMID: 29951211 PMCID: PMC6009991 DOI: 10.1002/osp4.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although obesity affects approximately one in five youths, only a fraction is treated in pediatric weight management clinics. Characteristics distinguishing youth with obesity who seek weight management treatment from those who do not are largely unknown. Yet identification of specific health characteristics which differentiate treatment-seeking from non-treatment seeking youth with obesity may shed light on underlying motivations for pursuing treatment. OBJECTIVES Compare the cardiometabolic profiles of an obesity treatment-seeking sample of youth to a population-based sample of youth with obesity, while controlling for body mass index (BMI). METHODS This cross-sectional study included participants, ages 12-17 years, with obesity from the Pediatric Obesity and Weight Evaluation Registry (POWER) and National Health and Nutrition Examination Survey, representing the treatment-seeking and population samples, respectively. Mean differences were calculated for systolic and diastolic blood pressure percentiles, total cholesterol, low-density and high-density lipoprotein-cholesterol, triglycerides, fasting glucose, glycated hemoglobin and alanine aminotransferase, while adjusting for age, sex, race/ethnicity, insurance status, and multiple of the 95th BMI percentile. RESULTS The POWER and National Health and Nutrition Examination Survey cohorts included 1,823 and 617 participants, respectively. The POWER cohort had higher systolic blood pressure percentile (mean difference 17.4, 95% confidence interval [14.6, 20.1], p < 0.001), diastolic blood pressure percentile (21.8 [19, 24.5], p < 0.001), triglycerides (42.3 [28, 56.5], p < 0.001) and alanine aminotransferase (7.5 [5.1, 9.8], p < 0.001) and lower fasting glucose (-6.9 [-8.2, -5.6], p < 0.001) and high-density lipoprotein-cholesterol (-2.3 [-3.8, -0.9], p < 0.002). There were no differences in total cholesterol or low-density lipoprotein-cholesterol or clinical differences in glycated hemoglobin. CONCLUSION For a given BMI, obesity treatment-seeking youth are more adversely affected by cardiometabolic risk factors than the general population of youth with obesity. This suggests that treatment-seeking youth may represent a distinct group that is at particularly high risk for the development of future cardiometabolic disease.
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Affiliation(s)
- C. K. Fox
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | - A. M. Kaizer
- Department of BiostatisticsUniversity of MinnesotaMinneapolisUSA
| | - J. R. Ryder
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | - K. D. Rudser
- Department of BiostatisticsUniversity of MinnesotaMinneapolisUSA
| | - A. S. Kelly
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | | | - A. C. Gross
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
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Abstract
Obesity prevalence continues to increase worldwide, as do the numerous chronic diseases associated with obesity, including diabetes, non-alcoholic fatty liver disease, dyslipidemia, and hypertension. The prevalence of bariatric surgery also continues to increase and remains the most effective and sustainable treatment for obesity. Over the last several years, numerous prospective and longitudinal studies have demonstrated the benefits of bariatric surgery on weight loss, mortality, and other chronic diseases. Even though the mechanisms underlying many of these beneficial effects remain poorly understood, surgical management of obesity continues to increase given its unmatched efficacy. In this commentary, we discuss recent clinical advancements as well as several areas needed for future research, including indications for bariatric and metabolic surgery, determination of responders and non-responders, metabolic surgery in non-obese individuals, and the evolving role of bariatric surgery in adolescents.
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Affiliation(s)
- Vance L Albaugh
- Department of Surgery, MCN CC-2308, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naji N Abumrad
- Department of Surgery, MCN CC-2308, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Smith OJ, Hachach-Haram N, Greenfield M, Bystrzonowski N, Pucci A, Batterham RL, Hashemi M, Mosahebi A. Body Contouring Surgery and the Maintenance of Weight-Loss Following Roux-En-Y Gastric Bypass: A Retrospective Study. Aesthet Surg J 2018; 38:176-182. [PMID: 29040424 DOI: 10.1093/asj/sjx170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss. OBJECTIVES We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery. METHODS We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups. RESULTS The %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P < 0.05). This trend continued (RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05). CONCLUSIONS Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.
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Affiliation(s)
- Oliver J Smith
- NIHR Academic Clinical Fellow in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Nadine Hachach-Haram
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | | | - Nicki Bystrzonowski
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Andrea Pucci
- Consultant Obesity Physician, Centre for Obesity Research, Department of Medicine, University College, London, UK
| | - Rachel L Batterham
- Professor of Obesity, Diabetes, and Endocrinology, Centre for Obesity Research, Department of Medicine, University College, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
| | - Majid Hashemi
- Consultant Upper GI and Bariatric Surgeon, UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
| | - Afshin Mosahebi
- Consultant Plastic, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Michalsky MP, Inge TH, Jenkins TM, Xie C, Courcoulas A, Helmrath M, Brandt ML, Harmon CM, Chen M, Dixon JB, Urbina EM. Cardiovascular Risk Factors After Adolescent Bariatric Surgery. Pediatrics 2018; 141:peds.2017-2485. [PMID: 29311357 PMCID: PMC5810605 DOI: 10.1542/peds.2017-2485] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Severely obese adolescents harbor numerous cardiovascular disease risk factors (CVD-RFs), which improve after metabolic and bariatric surgery (MBS). However, predictors of change in CVD-RFs among adolescents have not yet been reported. METHODS The Teen-Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected anthropometric and health status data on 242 adolescents undergoing MBS at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after Roux-en-Y gastric bypass and vertical sleeve gastrectomy were examined. RESULTS The mean (±SD) age of participants at baseline was 17 ± 1.6 years; 76% were girls, and 72% were white, with a median BMI of 51. Participants underwent Roux-en-Y gastric bypass (n = 161), vertical sleeve gastrectomy (n = 67), or adjustable gastric banding (n = 14). Increasing weight loss was an independent predictor of normalization in dyslipidemia, elevated blood pressure (EBP), hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Older participants at time of surgery were less likely to resolve dyslipidemia compared with younger participants, whereas girls were more likely than boys to demonstrate improvements in EBP. Even those participants without frank dyslipidemia or EBP at baseline showed significant improvements in lipid and blood pressure values over time. CONCLUSIONS Numerous CVD-RFs improve among adolescents undergoing MBS. Increased weight loss, female sex, and younger age predict a higher probability of resolution of specific CVD-RFs. The elucidation of predictors of change in CVD-RFs may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery designed to improve clinical outcomes.
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Affiliation(s)
- Marc P. Michalsky
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Thomas H. Inge
- University of Colorado, Denver, Colorado and Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Mary L. Brandt
- Texas Children’s Hospital, College of Medicine, Baylor University, Houston, Texas
| | | | - Mike Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John B. Dixon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and
| | - Elaine M. Urbina
- Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
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Effects of bariatric surgery on glycemic and lipid metabolism, surgical complication and quality of life in adolescents with obesity: a systematic review and meta-analysis. Surg Obes Relat Dis 2017; 13:2037-2055. [DOI: 10.1016/j.soard.2017.09.516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/28/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
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Abstract
PURPOSE In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain. METHODS The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed. RESULTS The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40. CONCLUSIONS Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.
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Pedroso FE, Angriman F, Endo A, Dasenbrock H, Storino A, Castillo R, Watkins AA, Castillo-Angeles M, Goodman JE, Zitsman JL. Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis. Surg Obes Relat Dis 2017; 14:413-422. [PMID: 29248351 DOI: 10.1016/j.soard.2017.10.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 01/06/2023]
Abstract
Of adolescents in the United States, 20% have obesity and current treatment options prioritize intensive lifestyle interventions that are largely ineffective. Bariatric surgery is increasingly being offered to obese adolescent patients; however, large-scale effectiveness data is lacking. We used MEDLINE, Embase, and Cochrane databases, and a manual search of references to conduct a systematic review and meta-analysis on overall weight loss after gastric band, gastric sleeve, and gastric bypass in obese adolescent patients (age ≤19) and young adults (age ≤21) in separate analyses. We provided estimates of absolute change in body mass index (BMI, kg/m2) and percent excess weight loss across 4 postoperative time points (6, 12, 24, and 36 mo) for each surgical subgroup. Study quality was assessed using a 10 category scoring system. Data were extracted from 24 studies with 4 having multiple surgical subgroups (1 with 3, and 3 with 2 subgroups), totaling 29 surgical subgroup populations (gastric band: 16, gastric sleeve: 5, gastric bypass: 8), and 1928 patients (gastric band: 1010, gastric sleeve: 139, gastric bypass: 779). Mean preoperative BMI (kg/m2) was 45.5 (95% confidence interval [CI]: 44.7, 46.3) in gastric band, 48.8 (95%CI: 44.9, 52.8) in gastric sleeve, and 53.3 (95%CI: 50.2, 56.4) in gastric bypass patients. The short-term weight loss, measured as mean (95%CI) absolute change in BMI (kg/m2) at 6 months, was -5.4 (-3.0, -7.8) after gastric band, -11.5 (-8.8, -14.2) after gastric sleeve, and -18.8 (-10.9, -26.6) after gastric bypass. Weight loss at 36 months, measured as mean (95%CI) absolute change in BMI (kg/m2) was -10.3 (-7.0, -13.7) after gastric band, -13.0 (-11.0, -15.0) after gastric sleeve, and -15.0 (-13.5, -16.5) after gastric bypass. Bariatric surgery in obese adolescent patients is effective in achieving short-term and sustained weight loss at 36 months; however, long-term data remains necessary to better understand its long-term efficacy.
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Affiliation(s)
- Felipe E Pedroso
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York.
| | | | - Atsushi Endo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hormuzdiyar Dasenbrock
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Neurological Surgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts
| | | | - Ricardo Castillo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ammara A Watkins
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Julie E Goodman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeffrey L Zitsman
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
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35
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Abstract
PURPOSE OF REVIEW Type 2 diabetes (T2D) is a growing public health problem in youth, but conventional treatments are often insufficient to treat this disease and its comorbidities. We review evidence supporting an emerging role for bariatric surgery as a treatment for adolescent T2D. RECENT FINDINGS Paralleling what has been seen in adult patients, bariatric surgery dramatically improves glycemic control in patients with T2D. In fact, remission of T2D has been observed in as many as 95-100% of adolescents with diabetes after bariatric surgery, particularly vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) surgery. This striking outcome may be due to both weight-dependent- and weight-independent factors, and recent studies suggest that T2D-related comorbidities may also improve after surgery. Bariatric surgery including RYGB and VSG is a powerful therapeutic option for obese adolescents with T2D. Benefits must be weighed against risk for postoperative complications such as nutritional deficiencies, but earlier surgical intervention might lead to more complete metabolic remission in obese patients with T2D.
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Affiliation(s)
- M A Stefater
- Division of Endocrinology, Boston Children's Hospital, Endocrinology CLS160.4 BCH3151, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - T H Inge
- Department of Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045-7106, USA
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Taylor SJA, Rennie K, Jon C. Clinical outcomes of an inpatient pediatric obesity treatment program in the USA. Int J Adolesc Med Health 2017; 31:ijamh-2016-0141. [PMID: 28598799 DOI: 10.1515/ijamh-2016-0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
Background When treating recalcitrant and severe childhood obesity, pharmaceutical options are limited and few patients qualify for bariatric surgery. A prolonged inpatient program serves as an alternative treatment. The purpose of this project was to describe the development of a medically supervised inpatient weight management program and evaluate its effectiveness. Methods This is a retrospective chart review of 18 patients [4-18 years, mean body mass index (BMI) 50.2 kg/m2] admitted to an inpatient pediatric weight management program from October 2011 through December 31, 2012 to evaluate the biometric, laboratory, sleep and behavioral changes that occurred from admission to discharge from the program. Results Average weight loss was 15% (6.9%-21.5%, p = 0.0001), the decrease in BMI was 15.1% (1.61-21.57, p = 0.0001), systolic blood pressure and diastolic blood pressure decreased by 7.2% (p = 0.003) and 10.3% (p = 0.040), respectively. The reduction in heart rate was 15% (p = 0.013). Upon admission, nine patients had obstructive sleep apnea syndrome (OSAS), of which one was treated with tonsillectomy and six were not compliant with home positive airway pressure (PAP) therapy. At discharge, three patients no longer required PAP and five required decreased PAP settings. Upon admission, seven patients met the criteria for an internalizing disorder. At discharge, symptom reduction was noted. Conclusion An intensive pediatric inpatient weight management program leads to successful weight loss, improvement in hemodynamic parameters, reduction in OSA treatment requirements and symptom improvement in anxiety and depressive disorders in obese children.
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Affiliation(s)
- Sharonda J Alston Taylor
- Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St. Suite 1710.00, Houston 77030, TX, USA
| | | | - Cindy Jon
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Texas Medical School - Houston, Houston 77030, TX, USA
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Mecoli M, Kandil A, Campion M, Samuels P. Pediatric Obesity: Anesthetic Implications and Perioperative Considerations for Weight Loss Surgery. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0211-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Beamish AJ, Reinehr T. Should bariatric surgery be performed in adolescents? Eur J Endocrinol 2017; 176:D1-D15. [PMID: 28174231 DOI: 10.1530/eje-16-0906] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/08/2016] [Accepted: 01/10/2017] [Indexed: 12/26/2022]
Abstract
Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.
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Affiliation(s)
- Andrew J Beamish
- Department of Gastrosurgical ResearchInstitute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
- Research DepartmentThe Royal College of Surgeons of England, London, UK
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents University of Witten/Herdecke Department of Pediatric EndocrinologyDiabetes, and Nutrition Medicine, Datteln, Germany
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Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:709-757. [PMID: 28359099 PMCID: PMC6283429 DOI: 10.1210/jc.2016-2573] [Citation(s) in RCA: 640] [Impact Index Per Article: 91.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
COSPONSORING ASSOCIATIONS The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
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Affiliation(s)
- Dennis M Styne
- University of California Davis, Sacramento, California 95817
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Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, Helmrath MA. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol 2017; 5:165-173. [PMID: 28065736 PMCID: PMC8282411 DOI: 10.1016/s2213-8587(16)30315-1] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/10/2016] [Accepted: 10/19/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the long-term outcomes of bariatric surgery for severe adolescent obesity, raising questions about the durability of early responses to surgery. We aimed to analyse long-term (>5 years) outcomes of Roux-en-Y gastric bypass in a cohort of young adults who had undergone the operation during adolescence, in the Follow-up of Adolescent Bariatric Surgery at 5 Plus Years (FABS-5+) extension study. METHODS A cohort of young people aged 13-21 years underwent Roux-en-Y gastric bypass for clinically severe obesity at a paediatric academic medical centre in the USA. We did a prospective follow-up analysis of these patients' outcomes 5-12 years after surgery. Outcomes assessed included BMI, comorbidities, micronutrient status, safety, and other risks. The FABS study is registered with ClinicalTrials.gov, number NCT00776776. FINDINGS Between May, 2001, and February, 2007, 74 young people underwent Roux-en-Y gastric bypass in the FABS study. Of these, 58 individuals were eligible for the FABS-5+ study, could be located, and agreed to follow-up assessment. At baseline, the mean age of the cohort was 17·1 years (SD 1·7) and mean BMI was 58·5 kg/m2 (10·5). At mean follow-up of 8·0 years (SD 1·6; range 5·4-12·5), the mean age of the cohort was 25·1 years (2·4) and mean BMI was 41·7 kg/m2 (12·0; mean change in BMI -29·2% [13·7]). From baseline to long-term follow-up, significant declines were recorded in the prevalence of elevated blood pressure (27/57 [47%] vs 9/55 [16%]; p=0·001), dyslipidaemia (48/56 [86%] vs 21/55 [38%]; p<0·0001), and type 2 diabetes (9/56 [16%] vs 1/55 [2%]; p=0·03). At follow-up, 25 (46%) of 58 patients had mild anaemia (ie, not requiring intervention), 22 (45%) had hyperparathyroidism, and eight (16%) had low amounts of vitamin B12 (ie, below the normal cutpoint). INTERPRETATION Roux-en-Y gastric bypass surgery resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults. Long-term health maintenance after Roux-en-Y gastric bypass should focus on adherence to dietary supplements and screening and management of micronutrient deficiencies. FUNDING Ethicon Endosurgery, National Center for Advancing Translational Sciences (US National Institutes of Health).
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Affiliation(s)
- Thomas H Inge
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Todd M Jenkins
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John B Dixon
- Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Stephen R Daniels
- Department of Pediatrics, Children's Hospital Colorado, Denver, CO, USA
| | - Meg H Zeller
- Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Massabki LHP, Sewaybricker LE, Nakamura KH, Mendes RT, Barros ADEA, Antonio MÂRDEGM, Zambon MP. Bariatric surgery: is it reasonable before the age of 16? Rev Col Bras Cir 2016; 43:360-367. [PMID: 27982330 DOI: 10.1590/0100-69912016005009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/06/2016] [Indexed: 08/30/2023] Open
Abstract
Objective: to assess the severity of obesity in children and adolescents through the presence of comorbidities and the potential indication of bariatric surgery. Methods: we conducted a cross-sectional study with clinical and laboratory data of the first consultation of patients at the childhood obesity clinic at a tertiary hospital from 2005 to 2013. We divided the patients into groups with or without potential indication for surgery, and recorded age, gender, birth weight, age of obesity onset, BMI Z score, presence of acanthosis nigricans, blood pressure, total cholesterol and fractions, triglycerides, blood glucose and fasting insulin, HOMA1-IR, CRP and ESR. The group with potential indication for surgery included: BMI > 40 or between 35-40 with comorbidities (Triglycerides >130mg/dl, glucose levels >100mg/dl, HOMA1-IR >3.16, Total Cholesterol >200mg/dl, LDL >130mg/dl and HDL <45mg/dl), regardless of age, epiphysis consolidation and previous treatment. Results: of the 296 patients included in the study, 282 (95.3%) were younger than 16 years. The most frequent change was the HDL (63.2%), followed by HOMA1-IR (37.5%). Of the group of 66 patients with potential indication for surgery (22.3%), only ten (15.1%) had more than 16 years. Acanthosis nigricans, the average HOMA1-IR, insulin, CRP, ESR, age, BMI Z score and systolic and diastolic blood pressure were significant in the group with potential surgical indication. Conclusion: bariatric surgery might be indicated by BMI and comorbidities in children and adolescents under 16 years. Objetivo: avaliar a gravidade da obesidade em crianças e adolescentes pela presença de comorbidades e pela potencial indicação de cirurgia bariátrica. Métodos: estudo transversal com dados clínicos e laboratoriais da primeira consulta de pacientes do ambulatório de obesidade infantil em um hospital terciário no período de 2005 a 2013. Os pacientes foram divididos em grupos com ou sem potencial indicação cirúrgica, e associados com idade, sexo, peso de nascimento, idade de início da obesidade, escore z de IMC, presença de acantose nigricans, pressão arterial, colesterol total e frações, triglicérides, glicemia e insulina de jejum, HOMA1-IR, PCR e VHS. O grupo com potencial indicação cirúrgica incluiu: IMC >40 ou IMC entre 35-40 com comorbidades (Triglicérides >130mg/dl, Glicemia >100mg/dl, HOMA1-IR >3,16, Colesterol total >200mg/dl, LDL >130mg/dl e HDL <45mg/dl), independente da idade, consolidação das epífises e tratamento prévio. Resultados: de 296 pacientes incluídos no estudo, 282 (95,3%) tinham menos de 16 anos. A alteração mais frequente foi a do HDL (63,2%), seguido do HOMA1-IR (37,5%). Do grupo de 66 pacientes com potencial indicação cirúrgica (22,3%), apenas dez (15,1%) tinham mais de 16 anos. Acantose nigricans, as médias de HOMA1-IR, insulina, PCR, VHS, idade, escore z de IMC e pressões sistólica e diastólica foram significantes no grupo com potencial indicação cirúrgica. Conclusão: os resultados sugerem que a cirurgia bariátrica, poderia estar indicada pelo IMC e presença de comorbidades, em crianças e adolescentes com menos de 16 anos.
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Affiliation(s)
- Lilian Helena Polak Massabki
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
| | - Letícia Esposito Sewaybricker
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
| | - Keila Hayashi Nakamura
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
| | - Roberto Teixeira Mendes
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
| | - Antonio DE Azevedo Barros
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
| | | | - Mariana Porto Zambon
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil
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Silva JS, Chaves GV, Stenzel AP, Pereira SE, Saboya CJ, Ramalho A. Improvement of anthropometric and biochemical, but not of vitamin A, status in adolescents who undergo Roux-en-Y gastric bypass: a 1-year follow up study. Surg Obes Relat Dis 2016; 13:227-233. [PMID: 27865810 DOI: 10.1016/j.soard.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/14/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to describe anthropometric, biochemical, co-morbidity, and vitamin A nutritional status in severely obese adolescents before and 30, 180, and 365 days after Roux-en-Y gastric bypass (RYGB). SETTING Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. METHODS Sixty-four adolescents (15-19 years old) with a body mass index≥40 kg/m2 were enrolled in a prospective follow-up study. Vitamin A status was evaluated before surgery (T0), and 30 (T30), 180 (T180), and 365 (T365) days after surgery, applying biochemical and functional indicators. Anthropometric measures, lipid profile, glycemia, and basal insulin also were assessed. No patients were lost during follow-up. RESULTS Before surgery, 26.6% of the sample group experienced vitamin A deficiency (VAD). Serum retinol levels dropped significantly 30 days after surgery and then returned to basal levels. There was a significant increase in the prevalence of β-carotene deficiency and night blindness throughout the postsurgery period. A significant reduction in blood glucose, insulin resistance, lipid profile, and anthropometric parameters was observed. CONCLUSION The finding that oral daily supplementation with 5000 IU retinol acetate failed to reverse VAD and night blindness after RYGB is highly significant. We recommend assessment of VAD and night blindness in extremely obese adolescents before and after RYGB. We further recommend monitoring for an additional 180 days (for VAD) and 365 days (for night blindness) after surgery, with particular attention to daily supplementation needs.
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Affiliation(s)
- Jacqueline Souza Silva
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Paula Stenzel
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Silvia Elaine Pereira
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos José Saboya
- Surgical Clinic, Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa Ramalho
- Department of Social and Applied Nutrition, Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Childhood obesity remains a significant public health issue. Approximately 8% of adolescent girls and 7% of adolescent boys have severe (≥class 2) obesity. Adolescent severe obesity is associated with numerous comorbidities, and persists into adulthood. Bariatric surgery is the most effective treatment available, resulting in major weight loss and resolution of important comorbid conditions. Clinical practice guidelines for pediatric obesity treatment recommend consideration of surgery after failure of behavioral approaches. Careful screening and postoperative management of patients by a multidisciplinary team is required. Long-term studies are needed to assess the impact of adolescent bariatric surgery.
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Affiliation(s)
- Nirav K Desai
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Mark L Wulkan
- Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, USA
| | - Thomas H Inge
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229-3039, USA
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Sondike SB, Pisetsky EM, Luzier JL. Development of significant disordered eating in an adolescent following gastric bypass surgery. Eat Weight Disord 2016; 21:133-6. [PMID: 26449853 PMCID: PMC5013654 DOI: 10.1007/s40519-015-0230-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022] Open
Abstract
The development of eating pathology is a concern following bariatric surgery, even in the absence of any pre-surgical psychopathology. No consistent risk factors have emerged in the literature to identify those at greatest risk. However, post-surgical guidelines encourage eating behaviors that would be considered disordered in other contexts. We present a case of an adolescent developing bulimia nervosa following gastric bypass surgery and the escalation of her symptoms from diligently following recommended food behaviors to a full-syndrome clinical eating disorder. We discuss the differences between appropriate post-surgical eating behaviors and disordered eating behaviors. We provide recommendations for clinicians to screen for eating pathology and referrals to an interprofessional treatment team to address eating disordered behaviors and cognitions.
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Affiliation(s)
- Stephen B Sondike
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Charleston, WV, USA. .,Charleston Area Medical Center, Charleston, WV, USA. .,Department of Pediatrics, West Virginia University School of Medicine, 830 Pennsylvania Avenue, Suite 103, Charleston, WV, 25302, USA.
| | - Emily M Pisetsky
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Charleston, WV, USA.,Charleston Area Medical Center, Charleston, WV, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Jessica L Luzier
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Charleston, WV, USA.,Charleston Area Medical Center, Charleston, WV, USA
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Nathan BM, Rudser KD, Abuzzahab MJ, Fox CK, Coombes BJ, Bomberg EM, Kelly AS. Predictors of weight-loss response with glucagon-like peptide-1 receptor agonist treatment among adolescents with severe obesity. Clin Obes 2016; 6:73-8. [PMID: 26683756 PMCID: PMC4721217 DOI: 10.1111/cob.12128] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/15/2015] [Accepted: 11/22/2015] [Indexed: 01/10/2023]
Abstract
In two previous, separate clinical trials, we demonstrated significant reductions in body mass index (BMI) with exenatide in adolescents with severe obesity. In the present study, we pooled data from these near identical trials to evaluate factors that may predict BMI reduction at 3 months. Data from 32 patients (mean age 14.3 ± 2.2 years; 69% female; mean BMI 39.8 ± 5.8 kg m(-2)) were included. Exenatide treatment consisted of 5 mcg twice daily for 1 month, followed by an increase to 10 mcg twice daily for 2 additional months. Predictor variables included baseline BMI, BMI percent change at 1 month, incidence of nausea or vomiting and baseline appetite and satiety measures. Treatment effects of percent change in BMI from baseline were estimated within predictor subgroups using generalized estimating equations with exchangeable working correlation and robust variance estimation for confidence intervals and P-values to account for paired observations. The pooled data treatment effect on absolute BMI at 3 months was -3.42% (95% confidence interval: -5.41%, -1.42%) compared to placebo. Within treated participants, appetite at baseline (treatment effect in high [-4.28%] vs. low [1.02%], P = 0.028) and sex (treatment effect in female [-4.78%] vs. male [0.76%], P = 0.007) were significant predictors of change in BMI at 3 months. Baseline BMI, BMI percent change at 1 month, age, incidence of nausea, vomiting, or other gastrointestinal symptoms and satiety scores did not predict 3-month responses. Sex and measures of appetite may serve as useful predictors of glucagon-like peptide-1 receptor agonist treatment response among adolescents with severe obesity.
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Affiliation(s)
- Brandon M. Nathan
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Kyle D. Rudser
- Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | | | - Claudia K. Fox
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Brandon J. Coombes
- Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Eric M. Bomberg
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Aaron S. Kelly
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
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Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, Harmon CM, Zeller MH, Chen MK, Xanthakos SA, Horlick M, Buncher CR. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med 2016; 374:113-23. [PMID: 26544725 PMCID: PMC4810437 DOI: 10.1056/nejmoa1506699] [Citation(s) in RCA: 465] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. METHODS We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure. RESULTS The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures. CONCLUSIONS In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micronutrient deficiencies and the need for additional abdominal procedures. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; Teen-LABS ClinicalTrials.gov number, NCT00474318.).
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Affiliation(s)
- Thomas H Inge
- From the Cincinnati Children's Hospital Medical Center (T.H.I., T.M.J., M.A.H., M.H.Z., S.A.X.) and the University of Cincinnati (C.R.B.), Cincinnati, and Nationwide Children's Hospital, Columbus (M.P.M.) - all in Ohio; the University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Women and Children's Hospital, University of Buffalo, Buffalo, NY (C.M.H.); University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.H.)
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Vilallonga R, Himpens J, van de Vrande S. Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years). Obes Facts 2016; 9:91-100. [PMID: 27035348 PMCID: PMC5644862 DOI: 10.1159/000442758] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few data are available about obesity surgery in adolescent patients. OBJECTIVE To assess long-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients <18 years. SETTING University Hospital, Europe. METHODS A retrospective study of prospectively collected data of patients <18 years (childhood group; ChG) (n = 28) treated by LRYGB of which 19 were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). This group of patients was matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period. The extensive survey included a telephonic questionnaire. RESULTS 19 (12 females) of the 28 patients (67.9%) were available for follow-up. Preoperatively, 3 had type 2 diabetes mellitus (T2DM), 1 arterial hypertension, 5 dyslipidemia and 1 sleep apnea. In the ChG, average BMI after 7 years dropped from 38.9 kg/m2 preoperatively to 27.5 kg/m2. In the AdG, average BMI decreased from 39.4 to 27.1 kg/m2 in the same time period (nonsignificant between groups). One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions). All patients resolved their initial comorbidities. Two of 12 female patients in the ChG became pregnant 6 and 8 years after surgery, respectively, despite seemingly adequate oral contraception. Compliance with postoperative guidelines was good in 16/19 patients in ChG and in 14/18 patients in the AdG. Overall degree of satisfaction was high: 8.2/10 (SD 1.2, range 6-10) in the ChG and 8.9/10 (SD 1.7, range 5-10) in the AdG. CONCLUSION LRYGB seems to be safe, provide good weight loss, and cure comorbidities in an adolescent population. Satisfaction degree is high. Inadvertent pregnancy despite conventional contraception is a possible issue.
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Affiliation(s)
- Ramon Vilallonga
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium
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Maffazioli GD, Stanford FC, Campoverde Reyes KJ, Stanley TL, Singhal V, Corey KE, Pratt JS, Bredella MA, Misra M. Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy. Front Pediatr 2016; 4:78. [PMID: 27508205 PMCID: PMC4960456 DOI: 10.3389/fped.2016.00078] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/14/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB vs. SG in this age-group are scarce. This study aims to compare short-term (1-6 months) and longer-term (7-18 months) body mass index (BMI) and biochemical outcomes following RYGB and SG in adolescents/young adults. METHODS A retrospective study using data extracted from medical records of patients 16-21 years who underwent RYGB or SG between 2012 and 2014 at a tertiary care academic medical center. RESULTS Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race, or BMI. BMI reductions were significant at 1-6 months and 7-18 months within groups (p < 0.0001), but did not differ by surgery type (p = 0.65 and 0.09, for 1-6 months and 7-18 months, respectively). Over 7-18 months, within-group improvement in low-density lipoprotein (LDL) (-24 ± 6 in RYGB, p = 0.003, vs. -7 ± 9 mg/dl in SG, p = 0.50) and non-high-density lipoprotein (non-HDL) cholesterol (-23 ± 8 in RYGB, p = 0.02, vs. -12 ± 7 in SG, p = 0.18) appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH), patients with Stage II-III NASH had greater reductions in alanine aminotransferase levels vs. those with Stage 0-I NASH (-45 ± 18 vs. -9 ± 3, p = 0.01) after 7-18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. CONCLUSION RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Giovana D Maffazioli
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Fatima Cody Stanford
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA; Weight Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine-Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Takara L Stanley
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Kathleen E Corey
- Department of Medicine-Gastroenterology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Janey S Pratt
- Weight Center, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
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49
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Inge TH, Prigeon RL, Elder DA, Jenkins TM, Cohen RM, Xanthakos SA, Benoit SC, Dolan LM, Daniels SR, D'Alessio DA. Insulin Sensitivity and β-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents. J Pediatr 2015; 167:1042-8.e1. [PMID: 26363548 PMCID: PMC4843108 DOI: 10.1016/j.jpeds.2015.08.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 06/18/2015] [Accepted: 08/05/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To test the hypothesis that insulin secretion and insulin sensitivity would be improved in adolescents after Roux-en-Y gastric bypass (RYGB). STUDY DESIGN A longitudinal study of 22 adolescents and young adults without diabetes undergoing laparoscopic RYGB (mean age 17.1 ± 1.42 years; range 14.5-20.1; male/female 8/14; Non-Hispanic White/African American 17/5) was conducted. Intravenous glucose tolerance tests were done to obtain insulin sensitivity (insulin sensitivity index), insulin secretion (acute insulin response to glucose ), and the disposition index as primary outcome variables. These variables were compared over the 1 year of observation using linear mixed modeling. RESULTS In the 1-year following surgery, body mass index fell by 38% from a mean of 61 ± 12.3 to 39 ± 8.0 kg/m(2) (P < .01). Over the year following surgery, fasting glucose and insulin values declined by 54% and 63%, respectively. Insulin sensitivity index increased 300% (P < .01), acute insulin response to glucose decreased 56% (P < .01), leading to a nearly 2-fold increase in the disposition index (P < .01). Consistent with improved β-cell function, the proinsulin to C-peptide ratio decreased by 21% (P < .01). CONCLUSIONS RYGB reduced body mass index and improved both insulin sensitivity and β-cell function in severely obese teens and young adults. These findings demonstrate that RYGB is associated with marked metabolic improvements in obese young people even as significant obesity persists. TRIAL REGISTRATION ClinicalTrials.gov: NCT00360373.
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Affiliation(s)
- Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Ronald L Prigeon
- University of Maryland School of Medicine, and Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Baltimore, MD
| | - Deborah A Elder
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert M Cohen
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH
| | | | - Stephen C Benoit
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH
| | | | | | - David A D'Alessio
- Division of Endocrinology, Diabetes and Metabolism, Duke University Medical Center, Durham, NC; Durham Veteran's Affairs Medical Center, Durham, NC
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50
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Bass R, Eneli I. Severe childhood obesity: an under-recognised and growing health problem. Postgrad Med J 2015; 91:639-45. [PMID: 26338983 DOI: 10.1136/postgradmedj-2014-133033] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 07/14/2015] [Indexed: 11/04/2022]
Abstract
Childhood obesity is a serious and urgent public health problem. In the last 10 years, there has been a concerted effort in the USA and globally to develop and implement educational, medical and public health interventions designed to attenuate its growth. The success of these efforts was probably responsible for the plateau in the prevalence rate of childhood obesity noted in the last two years. While the attenuation of the overall prevalence of childhood obesity is promising, data from the same cohort reveal a concerning upward trend in the number of children with severe obesity. The consequences of severe childhood obesity can be devastating. When compared to their moderately obese peers, children with severe obesity are at greater risk for adult obesity, early atherosclerosis, hypertension, type 2 diabetes, metabolic syndrome, fatty liver disease and premature death. The determinants for severe obesity include the same lifestyle, environmental, familial and societal risk factors reported for overweight or obesity. While all these risk factors must be screened for, genetic influences are distinct considerations that may have greater bearing especially with early-onset obesity. Treatments for severe childhood obesity include lifestyle intervention, specialised low-calorie diets and bariatric surgery. Outcomes of these treatments vary, with bariatric surgery clearly the most successful of the three for both short-term and long-term weight loss. Severe obesity in children and adolescents remains a challenging health condition. The enormous medical, emotional and financial burden these children and their families endure signals an urgent need to further investigate and standardise treatment modalities and improve outcomes.
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Affiliation(s)
- Rosara Bass
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
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