1
|
Heeren FAN, Ayzengart A, Menon S, Bernier AV, Cardel MI. Adolescent Bariatric Surgery: The Need for Tailored Educational Materials. Child Obes 2024; 20:221-226. [PMID: 37676982 DOI: 10.1089/chi.2023.0048] [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] [Indexed: 09/09/2023]
Abstract
Rates of class III, or greater, obesity have risen among adolescents in the United States. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for severe obesity among teenagers that results in improvements in cardiometabolic and psychosocial health. Despite its effectiveness, MBS remains largely underutilized and misconceptions exist among providers, parents/guardians, and adolescents. In addition, adolescents who have undergone MBS procedures report there are some topics they wish they had known more about before surgery and express concern that their unique needs are not understood. One potential solution to address these concerns includes preoperative educational materials tailored for adolescents. Currently, there are no standardized recommendations for preoperative educational materials. This editorial suggests the use of community-engaged research, and qualitative methodology, to consult with the primary stakeholder groups of preoperative adolescents, postoperative adolescents, parents/guardians, and clinicians to develop tailored materials that address the unique needs of adolescents undergoing surgical treatment for obesity.
Collapse
Affiliation(s)
- Faith Anne N Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Sarada Menon
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Angelina V Bernier
- Pediatric Endocrinology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
- WW International, Inc., New York, NY, USA
| |
Collapse
|
2
|
Liang NE, Herdes RE, Balili R, Pratt JSA, Bruzoni M. Sleeve gastrectomy for the treatment of adolescent obesity in children aged 13 and under: a retrospective study. Surg Obes Relat Dis 2024; 20:354-361. [PMID: 38195315 DOI: 10.1016/j.soard.2023.12.005] [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: 05/02/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) induces weight reduction and improves metabolic co-morbidities in children with severe obesity but remains underutilized, especially for young adolescents and preadolescents. OBJECTIVE We hypothesized there would be no differences in weight loss or co-morbidity resolution at 1 year post-SG in children who underwent SG at 13 years or younger compared to children who underwent SG at 17-18 years old. SETTING Academic medical center, United States. METHODS Medical records of children who underwent laparoscopic SG at a quaternary academic center from September 2014 to October 2022 were reviewed. A cohort of 15 patients, ≤13 years of age, was compared to a matched cohort of 15 older adolescent patients. Preoperative characteristics and postoperative outcomes were collected. RESULTS Both cohorts had similar baseline characteristics. Median preoperative body mass index (BMI) was 51.8 kg/m2 for the ≤13 cohort compared to 50.9 kg/m2 in the older cohort (P = .87). Time to postoperative enteral feeds and length of stay were similar between both groups, and there were no 30-day readmissions or immediate postoperative complications. Median percentage excess BMI loss at 1 year postoperation was 54% (IQR, 25.5%-94.5%) for the ≤13 cohort compared with 44% (IQR, 34.0%-51.0%) for the older cohort (P = .34). Two of 11 patients were lost to follow-up in the younger group compared to 4 of 15 in the older group (P = .61). Both groups demonstrated significant improvement in metabolic syndrome co-morbidities after SG. CONCLUSION SG in younger children is associated with successful postsurgical outcomes compared with adolescents, with effective weight loss and improvement of obesity-related metabolic co-morbidities.
Collapse
Affiliation(s)
- Norah E Liang
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California.
| | - Rachel E Herdes
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Stanford, California
| | - Rachelle Balili
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| | - Janey S A Pratt
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| | - Matias Bruzoni
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
3
|
Abstract
BACKGROUND In the US, obesity continues to be a severe health issue now affecting adolescents. Bariatric surgery remains the most effective treatment for obesity, but use among adolescents remains low. The objective of this study was to identify current national trends in bariatric surgery among adolescents. STUDY DESIGN Using the Nationwide Inpatient Sample database, adolescents aged 9 to 19 with a diagnosis of morbid obesity who underwent a laparoscopic gastric bypass (Roux-en-Y gastric bypass) or laparoscopic sleeve gastrectomy (SG) between 2015 and 2018 were identified. Demographics, comorbidities, and in-hospital complications were collected. National estimates were calculated. The trend of annual number of operations was determined by Kruskal-Wallis rank test. RESULTS Between 2015 and 2018, 1,203 adolescents were identified, resulting in a nationwide estimate of 4,807 bariatric cases. The number of bariatric operations increased annually from 1,360 in 2015 to 1,740 operations in 2018 (p = 0.0771). The majority of patients were female (76%), 17 to 19 years old (84.1%), and White (47.9%). Most patients underwent SG (82.0%). Black and Hispanic patients comprised 40.2% of the cohort. Significant comorbidities included diabetes, dyslipidemia, nonalcoholic fatty liver disease, hypertension, and sleep apnea. The average length of stay decreased from 2.12 days to 1.64 days. There were no in-hospital mortalities, and complications were less than 1%. CONCLUSIONS With the increasing prevalence of obesity among adolescents in the US, bariatric surgery increased over time but was performed less in patients younger than 16 years of age and racial minorities. Bariatric surgery among adolescents remains safe, with extremely low complication rates and zero in-hospital mortality.
Collapse
|
4
|
Ogle SB, Ressalam J, Baugh CM, Campbell EG, Kelsey MM, Inge TH. Referral and utilization of paediatric bariatric surgery in an academic freestanding children's hospital with dedicated paediatric bariatric programme. Pediatr Obes 2021; 16:e12830. [PMID: 34296818 DOI: 10.1111/ijpo.12830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This report estimates the percent of medically eligible adolescents who are referred for metabolic and bariatric surgery (MBS) evaluation or factors associated with referral. METHODS This cross-sectional retrospective review evaluated patients aged 13 to 18 years seen between 2017 and 2019 for demographics, insurance status, body mass index (BMI), obesity-related comorbidities, and compared these data to patients whom had been referred and received MBS. RESULTS Half of the patients (86 411/163137, 53%) between ages of 13 and 18 years identified had BMI documented, of which, 1974 (2.3%) were medically eligible for MBS, 238 (12%) were referred for MBS and 52 (22%) underwent MBS. Females had similar odds of being eligible for MBS [odds ratio (OR) = 1.01, 95% confidence interval (CI) 0.92-1.11, P = .9], but greater odds of referral (OR = 1.58, 95% CI 1.13-2.23, P = .009). Independently, miniorities and patients with public insurance had higher odds of being eligible for MBS, but similar odds of being referred as non-Hispanic white patients. Black patients with public insurance had greater odds of being referred for MBS (OR = 12.22, 95% CI 2.08-235.15, P = .022). Patients' multiple comorbidities had greater odds of being referred for MBS (OR = 2.16, 95% CI 1.29-3.68, P = .004). CONCLUSIONS Referral is barrier for patients medically eligible for MBS; however, this barrier is not uniformly faced by all patients.
Collapse
Affiliation(s)
- Sarah B Ogle
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA.,Department of Surgery, University of Colorado, Denver, Colorado, USA
| | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Eric G Campbell
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Megan M Kelsey
- Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Thomas H Inge
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA.,Department of Surgery, University of Colorado, Denver, Colorado, USA
| |
Collapse
|
5
|
van de Pas KGH, Bonouvrie DS, Janssen L, Roebroek YGM, Zegers BSHJ, Leclercq WKG, Vreugdenhil ACE, van Dielen FMH. Bariatric Surgery in Youth: the Perspective of Dutch Pediatricians, Parents, and Adolescents. Obes Surg 2021; 31:4821-4828. [PMID: 34357532 PMCID: PMC8490240 DOI: 10.1007/s11695-021-05648-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recent studies have indicated that bariatric surgery is effective for the treatment of youth with severe obesity. The attitudes of pediatricians, parents, and adolescents regarding this topic remain unclear. Therefore, the aim of this study was to assess the current thoughts and beliefs of Dutch pediatricians, parents, and adolescents regarding bariatric surgery in youth. METHODS An online survey containing twenty questions on bariatric surgery in youth was distributed to pediatricians of the Dutch Society of Pediatrics. Parents and adolescents who participated in an interdisciplinary care program for overweight, obesity, and severe obesity filled out an online survey of twelve questions. RESULTS One hundred and twenty-one pediatricians, 49 parents, and 19 adolescents completed the surveys. Seventy-two pediatricians (59.5%) considered bariatric surgery to be an effective treatment for youth with severe obesity when conventional treatment fails, and intend to refer patients for bariatric surgery. The most frequently suggested conditions for bariatric surgery were a minimum age of 16 years (n = 59, 48.7%), a BMI threshold of 40 kg/m2 (n = 51, 42.2%), and a minimum Tanner stage of IV (n = 59, 48.8%). Thirty parents (61.2%) and fourteen adolescents (73.7%) responded that bariatric surgery should become available for youth with severe obesity. CONCLUSION Dutch pediatricians, parents, and adolescents increasingly accept bariatric surgery as a treatment modality in youth with severe obesity who do not respond successfully to lifestyle intervention. Whether pediatricians will actually refer youth for bariatric surgery remains to be seen when this treatment option will be implemented in the Netherlands.
Collapse
Affiliation(s)
- Kelly G H van de Pas
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Daniëlle S Bonouvrie
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Yvonne G M Roebroek
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Bas S H J Zegers
- Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Anita C E Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | | |
Collapse
|
6
|
Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents. CHILDREN-BASEL 2021; 8:children8050372. [PMID: 34065140 PMCID: PMC8151410 DOI: 10.3390/children8050372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.
Collapse
|
7
|
Browne AF. Comment on: Parental attitudes toward bariatric surgery in adolescents with obesity. Surg Obes Relat Dis 2020; 16:e31. [PMID: 32044237 DOI: 10.1016/j.soard.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Allen F Browne
- Department of Surgery, Maine Medical Center, Falmouth, Maine
| |
Collapse
|