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Obeid NR, Gibbs KE, Faler B, Eckhouse S, Corcelles R, Alvarez R, Chen J, Husain F, Ghanem OM, Kroh M, Kurian M. The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on adjustable gastric banding. Surg Endosc 2024; 38:2964-2973. [PMID: 38714569 DOI: 10.1007/s00464-024-10812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/21/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Bariatric surgery is one of the clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, and laparoscopic adjustable gastric banding (LAGB) is one of the three anchoring bariatric procedures. To improve surgeon lifelong learning, the Masters Program seeks to identify sentinel articles of each of the 3 bariatric anchoring procedures. In this article, we present the top 10 articles on LAGB. METHODS A systematic literature search of papers on LAGB was completed, and publications with the most citations and citation index were selected and shared with SAGES Metabolic and Bariatric Surgery Committee members for review. The individual committee members then ranked these papers, and the top 10 papers were chosen based on the composite ranking. RESULTS The top 10 sentinel publications on LAGB contributed substantially to the body of literature related to the procedure, whether for surgical technique, novel information, or outcome analysis. A summary of each paper including expert appraisal and commentary is presented here. CONCLUSION These seminal articles have had significant contribution to our understanding and appreciation of the LAGB procedure. Bariatric surgeons should use this resource to enhance their continual education and acquisition of specialized skills.
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Affiliation(s)
- Nabeel R Obeid
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
| | - Karen E Gibbs
- Department of Surgery, Yale Medicine, New Haven, CT, USA
| | - Byron Faler
- Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Eisenhower, GA, USA
| | | | | | - Rafael Alvarez
- Department of Surgery, Mosaic Life Care, St Joseph, MO, USA
| | - Judy Chen
- Department of Surgery, University of Washington Medicine, Seattle, WA, USA
| | - Farah Husain
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marina Kurian
- Department of Surgery, New York University Langone Health, New York, NY, USA
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Beamish AJ, Ryan Harper E, Järvholm K, Janson A, Olbers T. Long-term Outcomes Following Adolescent Metabolic and Bariatric Surgery. J Clin Endocrinol Metab 2023; 108:2184-2192. [PMID: 36947630 PMCID: PMC10438888 DOI: 10.1210/clinem/dgad155] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Severe obesity in adolescence negatively impacts upon health and wellbeing. Lifestyle modifications do not usually achieve a sufficient degree or durability of weight loss to mitigate the risk of medical complications. In recent years, metabolic and bariatric surgery (MBS), already a well-established treatment for adults with severe obesity, has emerged as an option in adolescents. Controlled studies in this age group have demonstrated substantial and sustained weight loss, improvements in associated health parameters, and a safety profile surpassing that observed in adult patients. This review aims to present published data on the results of MBS in adolescents with a focus on long-term outcomes. Indications for bariatric surgery and aspects of timing in the young person's life are also presented, along with safety considerations and factors influencing patient selection for surgery. We conclude, predominantly from short- to medium-term outcomes data, that MBS is a safe and valuable therapeutic option for adolescents with severe obesity. Considering the poor health and social wellbeing prognosis in this group, MBS appears to be underutilized. The need for continued research, multiprofessional specialist provision, coherent contemporary clinical guidelines, and routine long-term follow-up in adolescents undergoing MBS is highlighted.
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Affiliation(s)
- Andrew J Beamish
- Department of General Surgery, Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, UK
- Department of Medicine, Swansea University Medical School, Swansea, UK
| | | | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatric Endocrinology, Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Torsten Olbers
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
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Lacrosniere SM, Dubern B, Pelta S, Karsenty A, Bernert C, Chantereau H, Oderda L, Lemoine A, Bouillot JL, Tounian P. Bariatric procedures including Roux-en-Y gastric bypass in French adolescents. Arch Pediatr 2023:S0929-693X(23)00096-9. [PMID: 37407324 DOI: 10.1016/j.arcped.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 09/11/2022] [Accepted: 06/04/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION In France, approximately 100 obese adolescents undergo a bariatric procedure every year. To date, only data from laparoscopic adjustable gastric banding (LAGB) or sleeve gastrectomy (SG) have been published. Our objective was to report the outcomes of a series of French obese adolescents who underwent a Roux-en-Y gastric bypass (RYGB). METHODS We included all obese adolescents aged 13-19 years who underwent RYGB in our department from 2008 with at least 2 years of follow-up after surgery. We analyzed the course of the anthropometric data, comorbidities, and subsequent adverse events. RESULTS Starting in September 2008, out of 93 obese adolescents who requested bariatric surgery, 39 (35%) underwent a bariatric procedure. From these adolescents, 2-year follow-up data were available for 26 patients who had a RYGB. At the time of surgery, the mean patient age was 17.4 years (standard deviation [SD]=1.4) and the body mass index (BMI) was 52.0 kg/m² (SD=7.8). One patient was lost to follow-up. At 2 years after surgery, the mean BMI was 35.7 kg/m² (SD=9.4) with a mean decrease in BMI of 31.9% (SD=11.6). Comorbidities improved for most of the patients: high blood pressure (2/2) and pseudotumor cerebri (1/1) were cured after surgery, and dyslipidemia improved globally. The complications observed were anemia, abdominal pain requiring celioscopy (n = 2), and oxalic nephrolithiasis. CONCLUSION Only one third of the obese adolescents requesting bariatric surgery were operated on. Our series including exclusively obese adolescents who underwent an RYGB presents the results of this technique on weight loss and comorbidities; mechanical and nutritional complications remain uncommon. These results are similar to those obtained in studies of adult patients.
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Affiliation(s)
| | - Béatrice Dubern
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France; Sorbonne University, Inserm Nutriomics, Paris, France
| | - Sarah Pelta
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Alexandra Karsenty
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Christine Bernert
- Sorbonne University, Inserm Nutriomics, Paris, France; Nutrition Department, Pitié-Salpêtrière, APHP, Paris, France
| | - Hélène Chantereau
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Leslie Oderda
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Anais Lemoine
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Jean-Luc Bouillot
- Digestive and Metabolic Surgery Department, Ambroise Paré Hospital, APHP, Paris, France
| | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France; Sorbonne University, Inserm Nutriomics, Paris, France.
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Levaillant L, Levaillant M, Sfeir N, Bouhours-Nouet N, Amsellem-Jager J, Beaumesnil M, Coutant R, Riquin É, Schmitt F. Factors Associated With Weight Loss After Laparoscopic Adjustable Gastric Banding in Adolescents With Severe Obesity. JPGN REPORTS 2023; 4:e296. [PMID: 37200715 PMCID: PMC10187845 DOI: 10.1097/pg9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 05/20/2023]
Abstract
Childhood obesity is associated with many comorbidities. Bariatric surgery is known to be efficient for reducing weight in adolescents. Objectives The primary outcome was to identify somatic or psychosocial factors associated with success at 24 months after a laparoscopic adjustable gastric banding (LAGB) procedure in our cohort of adolescents with severe obesity. Secondary endpoints were to describe weight loss outcomes, comorbidity resolution, and complications. Methods We have retrospectively reviewed medical records of patients who had LAGB placed between 2007 and 2017. Factors associated with success at 24 months after LAGB were researched, with success being defined as positive percentage of excess weight loss (%EWL) at 24 months. Results Forty-two adolescents underwent a LAGB procedure, the mean %EWL was 34.1% at 24 months, with improvement in most comorbidities and without major complications. Having lost weight before surgery was associated with success, whereas a high body mass index at surgery was associated with a higher risk of failure. No other factor was found to be associated with success. Conclusion Comorbidities mostly improved 24 months after LAGB and no major complication occurred. Having lost weight before surgery was associated with a successful surgery, whereas a high body mass index at surgery increases the risk of failure.
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Affiliation(s)
- Lucie Levaillant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Mathieu Levaillant
- Department of Methodology and Biostatistics, University Hospital of Angers, Angers, France
- University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Nathalie Sfeir
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Natacha Bouhours-Nouet
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Jessica Amsellem-Jager
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Marion Beaumesnil
- Department of Paediatric Physical and Rehabilitation Medicine, Centre des Capucins, Angers, France
| | - Régis Coutant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Élise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Mitovasc Unit, UMR CNRS 6015-INSERM, Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
| | - Françoise Schmitt
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
- Univ Angers, HIFIH, SFR ICAT, Angers, France
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Al-Mohaidly MT, Al-Asmari AK, Khan HA, Alshngeetee AS, Khan I, Al-Asmari YA, Al-Hussain GO, Alsalem SS, Khan A, Babtain AM, Aljorfi EA, Alshumiesy HA, Aluraifej MA. Laparoscopic sleeve gastrectomy for obesity treatment in adolescents and young adults: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:158. [PMID: 37093297 DOI: 10.1007/s00423-023-02894-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The incidence of obesity has been increasing in younger population, posing a significant impact on adolescents' life and health care system worldwide. METHODS We critically analyzed the existing literature on the use of laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity. We performed an in-depth evaluation of 37 studies and analyzed the effect of LSG in 2300 patients, aged ≤ 22 years. RESULTS Mean body mass index (BMI) loss after LSG was 17.81 kg/m2. Gastroesophageal reflux was the most common complication. Most of the patients showed remission of comorbidities including hypertension, diabetes, and obstructive sleep apnea after LSG. CONCLUSIONS These findings suggest that surgical intervention is highly beneficial for reducing BMI in appropriately selected adolescents and young adults suffering from obesity and comorbidities such as life-threatening obstructive sleep apnea.
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Affiliation(s)
- Mohammed T Al-Mohaidly
- Department of Pediatric Surgery, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
| | - Abdulrahman K Al-Asmari
- Scientific Research Center, Medical Service Department (MSD), Ministry of Defence, Riyadh, Saudi Arabia
| | - Haseeb A Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Ayshah S Alshngeetee
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Isra Khan
- Rohilkhand Medical College and Hospital, Bareilly, 243006, India
| | - Yaser A Al-Asmari
- Shaqra General Hospital, Ministry of Health (MOH), Shaqra, 15562, Saudi Arabia
| | - Ghadah O Al-Hussain
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sarah S Alsalem
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ayaat Khan
- Intigeral Institute of Medical Sciences and Research, Lucknow, 226026, India
| | - Aishah M Babtain
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ebtihaj A Aljorfi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Hend A Alshumiesy
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mashael A Aluraifej
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Herouvi D, Soldatou A, Paschou SA, Kalpia C, Karanasios S, Karavanaki K. Bariatric surgery in the management of childhood and adolescence obesity. Endocrine 2023; 79:411-419. [PMID: 36194346 DOI: 10.1007/s12020-022-03210-9] [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: 08/14/2022] [Accepted: 09/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nowadays, childhood obesity is literally a global pandemic health problem. According to current data, pediatric obesity is strongly associated with adult excess weight status as well as the development of certain co morbidities, already present in childhood, including cardiovascular disorders (dyslipidemia, hypertension), endocrine/metabolic (Type 2 diabetes, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal, and musculoskeletal problems. Additionally, children with obesity frequently experience psychosocial issues, such as mood disorders, anxiety, prejudice and low self-esteem. METHODS AND RESULTS The aim of this article was to evaluate whether or not bariatric surgery is an effective and safe treatment option for childhood obesity. This paper is based on a literature search in Pub Med for articles referring to the medical co morbidities and the results of different types of bariatric surgery for the treatment of childhood obesity (up to 18 years) until December 2021. The following keywords were used as MESH terms: childhood obesity, adolescence obesity, co morbidities and bariatric surgery. The bibliographic references of the studies found in these databases were also reviewed. CONCLUSION Although some researchers demonstrate that surgical interventions in adolescents might be a reliable intervention to lose weight in a maintainable way and reverse many of the co morbidities associated with severe obesity, their safety and long-term efficacy are still not clarified. Thus, large long-term prospective studies, with detailed recording of complications and co morbidity resolution are obviously needed in order to determine the role of surgical treatment in childhood obesity.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece.
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
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Williams K, Nadler EP. The Role of Devices in the Management of Pediatric Obesity. Curr Obes Rep 2022; 11:55-60. [PMID: 35737260 DOI: 10.1007/s13679-022-00476-y] [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: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Approximately 20% of children and adolescents in the USA suffer from obesity with significant long-term effects well into adulthood. Metabolic and bariatric surgery, although well adopted in the adult population, has been underutilized in children. RECENT FINDINGS There are four categories of weight loss devices regulated by the Food and Drug Administration for use in adults - gastric bands, gastric balloon systems, electrical stimulation systems, and gastric emptying systems. In this commentary we discuss the role these devices may play in increasing the adoption of procedural intervention for severe obesity in children and adolescents.
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Affiliation(s)
- Kibileri Williams
- Division of Pediatric Surgery, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
| | - Evan P Nadler
- Division of Pediatric Surgery, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
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Coronado-Sarmiento JF, Palencia-Palencia JI, Barraza-Leones OC. Cirugía bariátrica en pediatría, ¿qué impacto tiene? Revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La obesidad en la población pediátrica ha ido aumentando de manera progresiva y el manejo médico de la obesidad mórbida en esta población se ha mostrado insuficiente. El objetivo de este artículo fue describir el estado actual de la literatura científica publicada hasta abril 15 de 2021 sobre el impacto de la cirugía bariátrica en la población pediátrica.
Métodos. Se realizó una revisión de la literatura que evaluó dos bases de datos, donde se incluyeron revisiones sistemáticas, reportes de casos, series de casos y ensayos clínicos, publicados desde el 1 de enero de 2010 hasta el 15 de abril de 2021, en español, inglés y francés.
Resultados. Se incluyeron 56 documentos y 18 estudios clínicos, en los que se encontró que la cirugía bariátrica (bypass gástrico por Y de Roux, gastrectomía en manga, plicatura gástrica y banda gástrica) alcanzó una pérdida de peso significativa en el primer año, con un adecuado sostenimiento de dicha pérdida al quinto año, además de una resolución completa de las comorbilidades metabólicas y cardiovasculares en la mayoría de los pacientes.
Conclusión. La cirugía bariátrica se presenta como una alternativa eficaz en el manejo de la obesidad mórbida y sus complicaciones en el paciente pediátrico
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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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Abstract
OBJECTIVE This prospective cohort analysis describes changes in weight, cardiometabolic health, and weight-related quality of life (WRQOL) following adolescent LAGB. METHODS Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) collected demographic, anthropometric, micronutrient, cardiometabolic risk, and WRQOL data for 242 adolescents. Data through 5 years were analyzed for 14 participants who underwent LAGB with 2 patients lost to follow-up. RESULTS Participants (mean age 18.2 ± 0.4 years) were mostly female (86%) and white (71%) with a median body mass index (BMI) of 48.7 kg/m2 (45.5-54.1). Preoperatively, 100%(13/13), 62%(8/13), 57%(8/14), and 7%(1/14) had elevated high sensitivity C-reactive protein (hs-CRP), dyslipidemia, elevated blood pressure (EBP), and type 2 diabetes (T2D), respectively. At 5 years, mean BMI decreased by 3.3% (51.0 vs. 49.3 kg/m2, p = 0.6), 43%(6/14) had BMI values exceeding baseline and 21% (3/14) underwent band removal. Postoperative prevalence of hs-CRP, dyslipidemia, EBP, and T2D was 45% (4/11), 36% (5/11), 33% (4/12), and 0% (0/11), respectively. CONCLUSION Adolescents undergoing LAGB experienced modest initial weight loss and improvements in cardiovascular risk factors with later weight regain and frequent need for band removal. Despite the small sample size, this prospective study highlights long-term outcomes with high rates of participant retention over time. CLINICAL TRIAL REGISTRATION NCT00465829.
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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12
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Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg 2020; 29:3653-3664. [PMID: 31388963 DOI: 10.1007/s11695-019-04048-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metabolic and bariatric surgery is an effective strategy to curb the natural history of obesity progression and improve psychosocial status in the short term for adolescents with severe obesity. The medium- and long-term psychosocial impact of bariatric surgery in this population is not established. METHODS We searched MEDLINE (Ovid), EMBASE, Web of Science, PsycInfo, and the Cochrane Libraries through October 2017 for reports of weight loss surgery (roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding) on adolescents with severe obesity (age ≤ 21 years) having ≥ 6 months of follow-up. The primary outcome for inclusion in systematic review was use of a validated quality of life (QoL) or other psychosocial instrument at baseline and postoperatively. We used standardized mean difference (SMD) and random-effects modeling to provide summary estimates across different instruments. RESULTS We reviewed 5155 studies, of which 20 studies met inclusion criteria for qualitative synthesis. There were 14 studies and 9 unique cohorts encompassing 573 patients which were eligible for meta-analysis regarding postoperative change in QoL. Across surgical procedures, there was significant improvement in QoL of 1.40 SMD (95% confidence interval 0.95 to 1.86; I2 = 89%; p < 0.001) at last follow-up (range 9-94 months). Trends in QoL improvement demonstrated the greatest improvement at 12 months; however, significant improvement was sustained at longest follow-up of 60+ months. CONCLUSIONS Weight loss surgery is associated with sustained improvement in QoL for adolescents with severe obesity across surgical procedures. Long-term data for psychosocial outcomes reflecting other mental health domains is lacking.
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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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Roberts CA. Physical and Psychological Effects of Bariatric Surgery on Obese Adolescents: A Review. Front Pediatr 2020; 8:591598. [PMID: 33585363 PMCID: PMC7873639 DOI: 10.3389/fped.2020.591598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
The worldwide obesity crisis is not isolated to adults; rather, obesity in adolescents has reached epidemic levels as well. Bariatric surgery continues to be one of the most effective treatments for obesity, both in adults and adolescents, with new evidence continually emerging; however, research surrounding outcomes of these procedures in younger patients is limited in comparison with data available for adults. Further, it is important to examine psychological aspects of obesity in adolescents, as well as effects of surgery on mental health endpoints. Conditions such as anxiety, depression, anger, and disruptive behavior show increased prevalence among obese adolescents, but minimal research exists to examine changes in such conditions following bariatric surgery. Additionally, there is growing evidence of a bidirectional relationship between sleep (quality; disorders) and the development of obesity, and the effects of this relationship are particularly pronounced in the vulnerable adolescent population. This review aims to compile and discuss the results of literature within the last 5 years with regard to overall efficacy of bariatric surgery specifically in adolescent patients in terms of weight and body mass index (BMI) reduction, hormonal changes, and co-morbidity resolution, as well as data surrounding sleep and psychological outcomes. Race, ethnicity, and socioeconomic status were also examined. From this review, we conclude that current research supports bariatric surgery in adolescents as an effective method of treatment for obesity and related co-morbidities; however, minimal long-term data exists to adequately assess efficacy and trends into adulthood. These areas are ripe for future study.
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Affiliation(s)
- Cherie A Roberts
- Department of Nutrition, Columbia University, New York, NY, United States.,Department of Biomedical Sciences, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States.,Department of Osteopathic Medicine, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States
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15
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Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents-a National Registry-Based Study. Obes Surg 2019; 30:296-303. [PMID: 31478132 DOI: 10.1007/s11695-019-04155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents. METHODS A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases. RESULTS Two hundred fifty-nine adolescents (60% females) aged 12-19 years were included. Mean age and body mass index (BMI) were 17.5 ± 1.2 years and 45.1 ± 5.0 kg/m2, respectively. LSG (n = 227, 87.6%) and LAGB (n = 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 ± 4.7 kg/m2 vs. 10.3 ± 5.1 kg/m2 respectively; p = 0.0001) and higher rate with BMI < 30 kg/m2 1 year post-surgery (57.7% (n = 131) vs. 25% (n = 8), respectively; p = 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7-9.9) followed by age (OR = 1.3; 95% CI1.0-1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7-7.9; p = 0.1). CONCLUSION Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.
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Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, Inge T, Linden BC, Mattar SG, Michalsky M, Podkameni D, Reichard KW, Stanford FC, Zeller MH, Zitsman J. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis 2018; 14:882-901. [PMID: 30077361 PMCID: PMC6097871 DOI: 10.1016/j.soard.2018.03.019] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022]
Abstract
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
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Affiliation(s)
- Janey S A Pratt
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California.
| | - Allen Browne
- Diplomate American Board of Obesity Medicine Falmouth, Maine
| | - Nancy T Browne
- WOW Pediatric Weight Management Clinic, EMMC, Orono, Maine
| | - Matias Bruzoni
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California
| | - Megan Cohen
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | | | - Thomas Inge
- University of Colorado, Denver and Children's Hospital of Colorado Aurora, Colorado
| | - Bradley C Linden
- Pediatric Surgical Associates and Allina Health Minneapolis, Minnesota
| | - Samer G Mattar
- Swedish Weight Loss Services Swedish Medical Center Seattle, Washington
| | - Marc Michalsky
- Nationwide Children's Hospital and The Ohio State University Columbus, Ohio
| | - David Podkameni
- Banner Gateway Medical Center and University of Arizona Phoenix, Arizona
| | - Kirk W Reichard
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | - Fatima Cody Stanford
- Diplomate American Board of Obesity Medicine Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | - Jeffrey Zitsman
- Morgan Stanley Children's Hospital of NY Presbyterian and Columbia University Medical Center New York, New York
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17
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Riquin E, Schmitt F, Bouhours-Nouet N, Beaumesnil M, Dinomais M, Malka J, Robin M, Coutant R, Duverger P. Laparoscopic adjustable gastric banding in adolescents with severe obesity: Psychological aspects, decision makers of surgery, and 2-year outcomes. A case series. Arch Pediatr 2018; 25:269-273. [PMID: 29656036 DOI: 10.1016/j.arcped.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 01/31/2018] [Accepted: 02/18/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The results of medical treatment of severe obesity in the adolescent population (balanced diet and physical activity) are often unsatisfactory, and bariatric surgery is questioned. The psychological determinants for requesting bariatric surgery in these adolescents are unclear. The objective of this study was to report the psychiatric and psychological aspects as well as the determinants of the medical decision for surgery in a cohort of obese adolescents requesting bariatric surgery by laparoscopic adjustable gastric banding. METHODS Thirty-five adolescents (12.3-17.7 years of age), were recruited from January 2007 to December 2012. Semistructured interviews were conducted. RESULTS Fifty-four percent of the adolescents had a psychiatric history and 85% had psychiatric comorbidities. In adolescents undergoing surgery, excess weight loss was 46% after 1 year and 51% after 2years. For patients not receiving surgery, excess weight loss was 0.43% after 1 year (P=0.001). Compliance with medical treatment was the only significant element contributing to the decision to perform surgery. Results in terms of satisfaction and perception 1 and 2years after surgery were encouraging. CONCLUSION Bariatric surgery is feasible in young patients and produces good results in terms of excess weight loss. We argue that compliance with medical treatment is probably one of the most important elements for making the decision to perform bariatric surgery and in excess weight loss after surgery. We probably need to focus on the compliance of young patients and evaluate how this can be improved.
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Affiliation(s)
- E Riquin
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - F Schmitt
- Pediatric Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - N Bouhours-Nouet
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - M Beaumesnil
- Centre de rééducation des Capucins, 28, rue des Capucins, B.P. 40329, 49103 Angers cedex 02, France
| | - M Dinomais
- Centre de rééducation des Capucins, 28, rue des Capucins, B.P. 40329, 49103 Angers cedex 02, France
| | - J Malka
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - M Robin
- Pediatric Psychiatry Department, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - R Coutant
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Duverger
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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19
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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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Schroeder K, Smaldone A. What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention? J Sch Nurs 2017; 33:456-466. [PMID: 29108499 PMCID: PMC6080249 DOI: 10.1177/1059840517694967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school nurses. Data were analyzed using content analysis and heat mapping. Nineteen nurses participated and eight themes were identified. Parental and administrative gatekeeping, heavy nurse workload, obesogenic environments, and concerns about obesity stigma were barriers to implementation. Teamwork with parents and school staff was a key facilitator of implementation. Nurses also noted the importance of cultural considerations and highlighted the need to tailor the intervention to the unique needs of their school environment and student population. These findings suggest that for school nurses to play a key role in school-based obesity interventions, barriers must be identified and addressed prior to program implementation.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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21
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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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Bariatric surgery in adolescents with severe obesity: Review and state of the art in France. ANNALES D'ENDOCRINOLOGIE 2017; 78:462-468. [PMID: 28870706 DOI: 10.1016/j.ando.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/28/2017] [Accepted: 03/23/2017] [Indexed: 11/20/2022]
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Schroeder K, Jia H, Wang YC, Smaldone A. Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools. J Pediatr Nurs 2017; 35:16-22. [PMID: 28728763 PMCID: PMC6057478 DOI: 10.1016/j.pedn.2017.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/16/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination. DESIGN AND METHODS This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression. RESULTS During the 2012-2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP. CONCLUSIONS As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions. PRACTICE IMPLICATIONS Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.
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Affiliation(s)
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, USA.
| | - Y Claire Wang
- Columbia University Mailman School of Public Health, New York, NY, USA.
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Zeller MH, Pendery EC, Reiter-Purtill J, Hunsaker SL, Jenkins TM, Helmrath MA, Inge TH. From adolescence to young adulthood: trajectories of psychosocial health following Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 13:1196-1203. [PMID: 28465159 PMCID: PMC5891326 DOI: 10.1016/j.soard.2017.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) in adolescence results in substantial bodyweight reduction and cardiometabolic benefits into young adulthood. Knowledge gaps remain in understanding psychosocial health. OBJECTIVE Describe trajectories of weight and psychosocial health in adolescents who underwent RYGB into young adulthood. SETTING Academic Pediatric Medical Center. METHODS Fourteen adolescents (presurgery: mean body mass index = 59.2±8.9; mean age = 16.0±1.3 yr; 64.3% female) participated in 2 sequential observational studies. Height and weight were measured, and participants completed measures of weight-related quality of life (WRQOL), mental health, and adaptive functioning at presurgery and 6, 12, 18, 24, and 72+months postsurgery. Substance use behaviors were assessed at 72+months. RESULTS Modeling demonstrated rapid improvement in body mass index and WROQL across postoperative year 1, followed by stabilization and modest weight regain/WRQOL decline (P<.001), with 50% remaining severely obese. Presurgery, 11 adolescents presented with symptoms outside of the normal range for≥1 mental health domain. Postoperative profiles indicated either remittance (n = 5) or persistent symptomatology (n = 6: anxious/depressed, withdrawn/depressed, and/or thought problems) in young adulthood. No new incidence of mental health vulnerability occurred in young adults not already identified preoperatively. Adaptive functioning and substance use were within normal range. CONCLUSIONS Although adolescent RYGB resulted in improvement in weight and WRQOL into young adulthood, mental health trajectories were more variable, with some experiencing positive change while others experienced persistent mental health vulnerability. Research focused on larger contemporary samples using a controlled design is critical to inform targets for prevention and intervention to optimize both physical and psychosocial health outcomes in this younger patient population.
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Affiliation(s)
- Meg H Zeller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Emma C Pendery
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sanita L Hunsaker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd M Jenkins
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas H Inge
- Division of Pediatric Surgery; Children's Hospital Colorado, Aurora, Colorado
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Schmitt F, Topart P, Salle A, Sentilhes L, Bouhours-Nouet N, Coutant R, Weil D, Podevin G. Early postpartum gastric band slippage after bariatric surgery in an adolescent obese girl. J Surg Case Rep 2016; 2016:rjw155. [PMID: 27619323 PMCID: PMC5019157 DOI: 10.1093/jscr/rjw155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report here a case of a rarely described complication of laparoscopic adjustable gastric banding (LAGB), slippage during the postpartum period, after LAGB had been performed in an adolescent obese girl. The LAGB had been placed after one year of clinical survey initiated at the age of 16. Maximal pre-operative body mass index (BMI) was 48.5 kg.m(-2) and obesity was associated with insulin resistance. Before pregnancy, there was a loss of 17 Kg (final BMI = 41.5 kg.m(-2)) and a resolution of insulin resistance. The patient became pregnant 21 months after LAGB, and whole pregnancy and delivery were uneventful for both mother and fetus. Six weeks after delivery, the patient suddenly complained for total food intolerance, due to a band slippage, leading to removal of the band. Slippage is now a rare complication of LAGB, but can happen during pregnancy and the postpartum period as well.
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Affiliation(s)
- Françoise Schmitt
- Paediatric Surgery Department, University Hospital of Angers, Angers, France
| | - Philippe Topart
- General and Metabolic Surgery Department, Clinique de l'Anjou, Angers, France
| | - Agnès Salle
- Diabetes and Endocrinology Department, University Hospital of Angers, Angers, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, University Hospital of Angers, Angers, France
| | | | - Régis Coutant
- Pediatric Endocrinology Department, University Hospital of Angers, Angers, France
| | - Dominique Weil
- Paediatric Surgery Department, University Hospital of Angers, Angers, France
| | - Guillaume Podevin
- Paediatric Surgery Department, University Hospital of Angers, Angers, France
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