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Jalloh H, Andras LM, Sanders A, Iantorno S, Hamilton A, Choi PD, Skaggs DL. Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period. Medicine (Baltimore) 2023; 102:e32610. [PMID: 36701729 PMCID: PMC9857555 DOI: 10.1097/md.0000000000032610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child's clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.
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Affiliation(s)
- Hulaimatu Jalloh
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Lindsay M. Andras
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
- * Correspondence: Lindsay M. Andras, Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS #69, Los Angeles, CA 90027 (e-mail: )
| | - Austin Sanders
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Stephanie Iantorno
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Anita Hamilton
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Paul D. Choi
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - David L. Skaggs
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
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Franklin EV, Klement J, Mulpuri N, Qureshi FG. Mental health factors associated with progression to adolescent metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1855-1863. [PMID: 34281804 DOI: 10.1016/j.soard.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While bariatric surgery has demonstrated significant weight loss for adolescents with severe obesity, only a limited number of adolescents referred to surgery successfully complete the surgical program. Better identification of pre-surgical factors, especially mental health factors, associated with completing bariatric surgery may determine successful referrals to surgical programs versus alternative behavioral health interventions. OBJECTIVES The primary objective of this article was to investigate the relationship between presurgical mental health factors and whether or not a patient received bariatric surgery within the first six months of entering the program. SETTING Pediatric Children's Hospital, Bariatric Surgery Program within Pediatric Surgery Department. METHODS A retrospective medical record review of all patients referred from 2016 to 2019 to an adolescent surgical weight loss program was conducted. Patients were determined as completers if they received a laparoscopic sleeve gastrectomy within 6 months of entering the program. Demographic and preoperative mental health factors among completers (n = 30) were compared with surgery noncompleters (n = 44) using enter method logistic regression. RESULTS Regression analyses revealed that younger patients, White patients, patients with lower internalizing symptoms on a standardized measure, and patients with greater self-reported motivation for surgery at their initial surgery visit were more likely to obtain surgery within 6 months of starting the program. CONCLUSION The findings underscore the importance of assessing patients' motivation early in the bariatric surgery referral process. This study highlights potential treatment implications in how best to mitigate patient barriers, such as internalizing symptoms and low motivation, to pursue bariatric surgery and remain committed to weight loss goals through techniques such as motivational interviewing.
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Affiliation(s)
| | - Jessica Klement
- University of Texas Southwestern Medical School, Department of Pediatrics and Surgery, Dallas, Texas
| | - Neha Mulpuri
- University of Texas Southwestern Medical School, Department of Pediatrics and Surgery, Dallas, Texas
| | - Faisal G Qureshi
- University of Texas Southwestern Medical School, Department of Pediatrics and Surgery, Dallas, Texas
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3
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Burton ET, Mackey ER, Reynolds K, Cadieux A, Gaffka BJ, Shaffer LA. Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations. J Clin Psychol Med Settings 2021; 27:235-246. [PMID: 32333235 DOI: 10.1007/s10880-020-09717-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The rising rates of severe obesity among adolescents in the United States indicate a dire need for more intensive weight management strategies. While current evidence suggests that bariatric surgery is a safe and efficacious intervention for adolescents, the linkages with psychopathology before and after surgery are not well understood. Psychologists are an integral part of the interdisciplinary surgery team and play an important role in preparing youth for bariatric surgery as well as supporting adolescents post-surgery. The present manuscript reviews the literature on psychopathology in the context of adolescent bariatric surgery, discusses consideration of psychopathology as a contraindication for surgery, and provides recommendations on how psychologist members of the bariatric surgery team may balance attention to motivation and adherence to medical recommendations with assessment and treatment of psychopathology. Finally, the importance of continued research to confirm clinical consensus regarding decision-making and expansion of psychological resources within adolescent bariatric surgery programs are discussed.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Room 452R, Memphis, TN, 38103, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Health System, Washington, DC, USA.,Department of Psychiatry and Behavioral Science, The George Washington University School of Medicine, Washington, DC, USA
| | - Kimberly Reynolds
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Adelle Cadieux
- Helen DeVos Children's Hospital, Grand Rapids, MI, USA.,Michigan State University, East Lansing, MI, USA
| | - Bethany J Gaffka
- Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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4
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Messiah SE, Sacher PM, Yudkin J, Qureshi FG, Hoelscher DM, Barlow SE. Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity. Obesity (Silver Spring) 2019; 27:1784-1795. [PMID: 31562699 DOI: 10.1002/oby.22612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Rates of adolescents with severe obesity continue to rise worldwide, with concurrent increases in metabolic and bariatric surgery (MBS) uptake. The gap between support (lifestyle, pharmacotherapy) interventions and MBS as treatment options for adolescents has been understudied. This review, couched in a socio-ecological framework, investigates how support interventions for adolescents with severe obesity could be combined or sequenced with MBS to optimize health outcomes. METHODS A comprehensive search revealed 36 published articles between 1995 and 2019 that included the combination of support interventions and MBS among adolescents. RESULTS There were no studies that specifically reported outcomes or effect sizes for the combination of lifestyle intervention with MBS. Previous studies have reported individual results for either lifestyle intervention or MBS but not for their compound effect. CONCLUSIONS As rates of adolescents with severe obesity are on the rise globally, future research should focus on how partnering support interventions with MBS can amplify positive short- and long-term health outcomes and within a socio-ecological framework. Understanding the sequence of these approaches will be of particular importance. High-risk and vulnerable populations such as ethnic minorities who have suffered a disproportionate burden of the obesity epidemic must be included in rigorously tested future trials of combination interventions to maximize health outcomes worldwide.
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Affiliation(s)
- Sarah E Messiah
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College London, London, UK
| | - Joshua Yudkin
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deanna M Hoelscher
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
- Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Brode C, Ratcliff M, Reiter-Purtill J, Hunsaker S, Helmrath M, Zeller M. Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery. Obes Surg 2019; 28:2853-2859. [PMID: 29687342 DOI: 10.1007/s11695-018-3261-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Factors contributing to adolescents' non-completion of bariatric surgery, defined as self-withdrawal during the preoperative phase of care, independent of program or insurance denial, are largely unknown. Recent adolescent and adult bariatric surgery literature indicate that psychological factors and treatment withdrawal play a role; however, for adolescents, additional age-salient (family/caregiver) variables might also influence progression to surgery. OBJECTIVES The present study examined demographic, psychological, and family/caregiver variables as predictors of whether adolescents completed surgery ("completers") or withdrew from treatment ("non-completers"). SETTING Adolescents were from a bariatric surgery program within a pediatric tertiary care hospital. METHODS A retrospective chart review was conducted of consecutive patients who completed bariatric surgery psychological intake evaluations from September 2009 to April 2013. Data involving completer (n = 61) versus non-completer (n = 65) status were analyzed using two-tailed independent t tests, Chi-squared tests, and logistic regressions. RESULTS Forty-three percent of adolescents completed surgery, similar to adult bariatric samples. Significantly more males were non-completers (p < .05), and there was a trend towards non-completion for older adolescents (p = 0.06). No other demographic, psychological, or caregiver/family variables were significant predictors of non-completion. CONCLUSIONS These findings indicate that demographic variables, rather than psychological or family factors, were associated with the progression to or withdrawal from surgery. Further assessment is needed to determine specific reasons for completing or withdrawing from treatment, particularly for males and older adolescents, to improve clinical care and reduce attrition.
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Affiliation(s)
- Cassie Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV, 26505, USA.
| | | | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sanita Hunsaker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael Helmrath
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Meg Zeller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Reiter-Purtill J, Ley S, Kidwell KM, Mikhail C, Austin H, Chaves E, Rofey DL, Jenkins TM, Inge TH, Zeller MH. Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery. Int J Obes (Lond) 2019; 44:1467-1478. [PMID: 31209270 PMCID: PMC6918011 DOI: 10.1038/s41366-019-0394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 01/27/2023]
Abstract
Background/Objectives: Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a non-surgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes. Subjects/Methods: Multi-site data from 139 adolescents undergoing bariatric surgery (Mage=16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI]= 51.5kg/m2) and 83 comparators (Mage=16.1; 81.9 % female, 54.2% White; MBMI= 46.9kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes. Results: Significant improvement in WRQOL and Physical HRQOL, particularly in the first post-operative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had signficantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were signficantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating. Conclusions: For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early post-operatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.
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Affiliation(s)
| | - Sanita Ley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Heather Austin
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eileen Chaves
- Nationwide Children's Hospital Medical Center, Columbus, OH, USA
| | - Dana L Rofey
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Khoursheed M, Al-Bader I, Mouzannar A, Ashraf A, Al-Haddad A, Sayed A, Alsalim A, Fingerhut A. Laparoscopic Sleeve Gastrectomy for Morbid Obesity in Kuwaiti Adolescents. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mousa Khoursheed
- Department of Surgery, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Ibtisam Al-Bader
- Department of Surgery, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Ali Mouzannar
- Department of Surgery, Mubarak Hospital, Kuwait City, Kuwait
| | - Aqeel Ashraf
- Department of Surgery, Mubarak Hospital, Kuwait City, Kuwait
| | | | - Ali Sayed
- Department of Surgery, Mubarak Hospital, Kuwait City, Kuwait
| | - Ahmad Alsalim
- Department of Surgery, Mubarak Hospital, Kuwait City, Kuwait
| | - Abe Fingerhut
- Department of Surgery, Surgical Research Unit Graz, Medical University of Graz, Graz, Austria
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8
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Adolescent Bariatric Surgery: Current Concepts and Future Directions. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Pre-surgical Weight Loss Predicts Post-surgical Weight Loss Trajectories in Adolescents Enrolled in a Bariatric Program. Obes Surg 2019; 29:1154-1163. [DOI: 10.1007/s11695-018-03649-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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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: 264] [Impact Index Per Article: 44.0] [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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11
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Mackey ER, Wang J, Harrington C, Nadler EP. Psychiatric Diagnoses and Weight Loss Among Adolescents Receiving Sleeve Gastrectomy. Pediatrics 2018; 142:peds.2017-3432. [PMID: 29858452 DOI: 10.1542/peds.2017-3432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Severe obesity is associated with higher risk of psychiatric difficulties. Bariatric surgery is the most effective treatment of severe obesity. Few guidelines exist regarding the association of psychiatric diagnoses in adolescents and outcomes after surgery because of the lack of longitudinal research. Our objective is to evaluate the rates of psychiatric diagnoses in adolescents undergoing surgery compared with those not receiving surgery and the association of preoperative psychiatric diagnoses with postsurgical weight loss outcomes. METHODS Adolescents (N = 222) referred for psychological evaluation at one institution for bariatric surgery (2009-2017) completed semistructured clinical interviews to assess the presence and number of psychiatric diagnoses. Comparison analyses were conducted between those who did not end up receiving surgery (N = 53) and those who did (N = 169). Using longitudinal modeling, we assessed the association of preoperative diagnoses with weight loss outcomes between 3 and 12 months after surgery. RESULTS Seventy-one percent of adolescents qualified for a psychiatric disorder. There were no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. CONCLUSIONS Psychiatric diagnoses are prevalent among adolescents with severe obesity. These diagnoses are not associated with weight loss outcomes. The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery.
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Affiliation(s)
- Eleanor R Mackey
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Chloe Harrington
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Evan P Nadler
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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