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Bezerra A, Boppre G, Freitas L, Battista F, Duregon F, Faggian S, Busetto L, Ermolao A, Fonseca H. Body Composition Changes in Adolescents Who Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Curr Obes Rep 2024; 13:107-120. [PMID: 38172484 PMCID: PMC10933211 DOI: 10.1007/s13679-023-00549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis is to characterize the changes in body composition of children and adolescents who underwent bariatric surgery and identify possible negative effects of performing this procedure during pediatric ages. RECENT FINDINGS Bariatric surgery in children and adolescents is an emerging strategy to promote higher and faster body weight and fat mass losses. However, possible negative effects usually observed in surgical patients' muscle-skeletal system raise a major concern perform this intervention during growth. Despite these possible issues, most experimental studies and reviews analyze bariatric surgery's effectiveness only by assessing anthropometric outcomes such as body weight and BMI, disregarding the short- and long-term impact of bariatric surgery on all body composition outcomes. Bariatric surgery is effective to reduce fat mass in adolescents, as well as body weight, waist circumference, and BMI. Significant reduction in lean mass and fat-free mass is also observed. Bone mass seems not to be impaired. All outcomes reduction were observed only in the first 12 months after surgery. Sensitivity analysis suggests possible sex and type of surgery-related differences, favoring a higher fat mass, body weight, and BMI losses in boys and in patients who underwent RYGB.
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Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human Motricity Research Center, University Adventista, Chillean, Chile
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Sara Faggian
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018. Ann Surg 2022; 276:324-333. [PMID: 32941272 PMCID: PMC9825050 DOI: 10.1097/sla.0000000000004493] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Class II (120% > body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI >140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for with class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes. BACKGROUND The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US with class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates. METHODS The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000. RESULTS Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults ( P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend < 0.001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006). CONCLUSIONS MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.
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Messiah SE, Xie L, Mathew MS, Marroquin Marroquín E, Almandoz JP, Qureshi FG, Schneider BE, de la Cruz-Muñoz N. Impact of the COVID-19 Pandemic on Metabolic and Bariatric Surgery Utilization and Safety in the United States. Obes Surg 2022; 32:2289-2298. [PMID: 35499637 PMCID: PMC9059108 DOI: 10.1007/s11695-022-06077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA.
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA.
- Children's Health System of Texas, Dallas, TX, USA.
| | - Luyu Xie
- Children's Health System of Texas, Dallas, TX, USA
| | - Matthew Sunil Mathew
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Children's Health System of Texas, Dallas, TX, USA
| | - Elisa Marroquin Marroquín
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Children's Health System of Texas, Dallas, TX, USA
| | - Jaime P Almandoz
- Department of Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Faisal G Qureshi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Anekwe CV, Knight MG, Seetharaman S, Dutton WP, Chhabria SM, Stanford FC. Pharmacotherapeutic options for weight regain after bariatric surgery. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2021; 19:524-541. [PMID: 34511864 PMCID: PMC8425280 DOI: 10.1007/s11938-021-00358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW We sought to critically evaluate the recent literature published over the past 3 years on the topic of weight regain after bariatric surgery in children, adolescents, and adults, with an emphasis on clinically- relevant information for pharmacologic treatment of weight regain after metabolic and bariatric surgery. FINDINGS There are multiple pharmacotherapeutic agents available to treat obesity in children, adolescents, and adults; these agents have varying efficacy and indications for use and have been studied in a variety of clinical and research scenarios. We present an overview of these findings. SUMMARY This review represents a comprehensive compilation of the recently published data on efficacy of anti-obesity pharmacotherapy in the treatment of weight regain after bariatric surgery for children, adolescents, and adults.
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Affiliation(s)
- Chika Vera Anekwe
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael G. Knight
- Division of General Internal Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sujatha Seetharaman
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA
| | - Wesley P. Dutton
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA
| | - Shradha M. Chhabria
- Geisinger Commonwealth School of Medicine, Scranton, PA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology-Neuroendocrine Unit, Department of Pediatrics-Division of Endocrinology Boston, MA
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Johnson VR, Northam KA, Smith JJ, Newsome FA, Gomez G, Stanford FC. Hearing Their Voices: Exploring the Patient Narratives of Adolescent and Young Adults Who Have Undergone Metabolic and Bariatric Surgery-A Case Series. MEDICAL RESEARCH ARCHIVES 2021; 9:10.18103/mra.v9i5.2419. [PMID: 34458568 PMCID: PMC8389424 DOI: 10.18103/mra.v9i5.2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe obesity in adolescence and young adulthood is undertreated which leads to obesity-related chronic diseases that progress into adulthood. Many organizations including the American Academy of Pediatrics (AAP) support early consideration of metabolic and bariatric surgery (MBS) in the pediatric population to reduce morbidity and mortality. METHODS Five diverse patients who underwent metabolic and bariatric surgery (MBS) in the form of a Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) contributed patient narratives that captured their life, with a focus on health related quality of life, before and after MBS. RESULTS MBS leads to significant improvement in health status via decreased mortality and improved health related quality of life. CONCLUSION The perspectives of those patients who have undergone surgery in adolescence and young adulthood are not adequately captured in the medical literature. While the featured voices are not representative of all, their narratives may increase awareness and utilization of MBS in the treatment of severe obesity in the pediatric population.
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Affiliation(s)
- Veronica R. Johnson
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine
| | - Kayla A. Northam
- Simmons University, Boston, MA
- Brigham and Women’s Faulkner Hospital, Boston, MA
| | | | | | - Gricelda Gomez
- Department of Surgery-Urology, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA
- Neuroendocrine Unit, Pediatric Endocrinology, MGH Weight Center, and Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Pontiroli AE, Ceriani V, Tagliabue E. Compared with Controls, Bariatric Surgery Prevents Long-Term Mortality in Persons with Obesity Only Above Median Age of Cohorts: a Systematic Review and Meta-Analysis. Obes Surg 2021; 30:2487-2496. [PMID: 32152843 DOI: 10.1007/s11695-020-04530-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Compared to medical treatment, bariatric surgery reduces long-term mortality in persons with obesity. Some studies indicate that the effect only applies to patients above median age of cohorts, not to younger patients. Our objective was to assess the role of age in the reduction of mortality (global mortality and mortality for specific causes) through bariatric surgery. MATERIALS AND METHODS Data sources: PubMed, Cochrane Library, MEDLINE, and Embase. STUDY SELECTION studies reporting mortality in relation to median age of patients. DATA EXTRACTION AND SYNTHESIS pooled random effects of estimates of the risk of mortality in participants undergoing surgery compared with controls, as function of median age. RESULTS Mortality was lower in patients undergoing surgery than in controls (OR = 0.29, 95% CI 0.17-0.49). Below median age, the difference between surgery patients and controls was nonsignificant (OR = 0.78, 95% CI 0.57-1.06). Above median age, the difference was significant (OR = 0.23, 95% CI 0.12-0.44). In a subset of 5 studies, deaths due to various causes were less, and external causes-related deaths were more frequent in surgery than in controls. Below median age, deaths due to CVD were less frequent in surgery than in controls. Above median age, total deaths and deaths due to various causes (cardiovascular, diabetes, cancer, and other causes) were less in surgery than in controls. Publication bias was absent. CONCLUSION Compared with controls, bariatric surgery reduces long-term global mortality only above median age, not below median age. Also mortality due to specific causes is mainly reduced in persons above median age.
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Affiliation(s)
- Antonio E Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio di Rudinì 8, 20142, Milan, Italy.
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Campoverde Reyes KJ, Perez NP, Czepiel KS, Shaw AY, Stanford FC. Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians. Obesity (Silver Spring) 2021; 29:159-170. [PMID: 33184987 PMCID: PMC7902290 DOI: 10.1002/oby.22990] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Significant variability exists in the amount of formal obesity training obtained by physicians caring for pediatric patients. The study objective was to assess the relationship between formal obesity training and pediatrics physicians' perceptions, practice patterns, overall knowledge, and confidence during management of pediatric obesity. METHODS An anonymous survey was distributed via email from February 2020 through March 2020 at a large academic system. Internal medicine/pediatrics (46 total) and pediatrics (104 total) primary care providers were selected. Data were collected on the total number of obesity-related training hours by quartiles, demographics, physicians' clinical practice patterns, and physicians' knowledge of pediatric obesity management, along with their perceptions, attitudes, and beliefs. RESULTS A total of 73 survey participants completed the survey: 69% were female, 77% were older than 40 years, and 74% were White. Physicians with the highest training were most likely to feel confident when managing pediatric obesity. However, only 20% of all physicians felt confident providing pre- and post-bariatric surgery care, and just 6% of physicians self-reported achieving management success. CONCLUSIONS Increased obesity training improves physicians' confidence and leads to familiarity with management guidelines. Formal obesity training should be prioritized during residency and beyond so that physicians who care for pediatric patients are better equipped to offer unbiased and effective care.
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Affiliation(s)
- Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Numa P. Perez
- Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA
| | - Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ashley Y. Shaw
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Nutrition Obesity Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity. Surg Obes Relat Dis 2020; 17:398-405. [PMID: 33097449 DOI: 10.1016/j.soard.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the modest effects of behavioral treatment on obesity in adolescence, bariatric surgery is rarely performed. Obesity often persists from childhood to adulthood, but it is not known how many individuals proceed with bariatric surgery in young adulthood. OBJECTIVE The aim of this study was to determine what proportion of individuals who received pediatric behavioral obesity treatment subsequently underwent bariatric surgery in early adulthood, and to identify predictors thereof. SETTING National registries, Sweden. METHODS In this prospective cohort study, the Swedish Childhood Obesity Treatment Register was linked to several national registers. RESULTS The childhood obesity cohort included 6502 (45% females) with a median age at follow-up of 21.7 years (interquartile range [IQR] 5.2). Of these, 8.2% underwent bariatric surgery at a median age of 20.9 years (IQR 4.2). The estimated cumulative incidence of bariatric surgery at age 30 was 21.5%. Obesity-related co-morbidities were identified in 31.7% before bariatric surgery in the childhood obesity cohort. Predictors of bariatric surgery were female sex, high body mass index standard deviation score (BMI SDS) at the start and end of treatment, poor treatment response, as well as own or parental cardiometabolic disease. CONCLUSIONS More than a fifth are estimated to undergo bariatric surgery in early adulthood, despite having received pediatric behavioral obesity treatment. Our results indicate that for many children, behavioral treatment is insufficient in reducing obesity and preventing obesity-related co-morbidity. Therefore, it is reasonable to assume that more effective treatment of adolescents with severe obesity, including more rigorous behavioral support and pharmacologic treatment, but also more frequent use of bariatric surgery, would benefit this group of patients.
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Abstract
PURPOSE OF REVIEW The prevalence of pediatric obesity and its associated complications is increasing around the world. Treatment of obesity is challenging and metabolic and bariatric surgery (MBS) is currently the most effective treatment for this condition. At this time, vertical sleeve gastrectomy (VSG) is the most commonly performed bariatric procedure in adolescents. However, knowledge regarding the efficacy, safety, and durability of VSG in adolescents is still evolving. This review summarizes the most recent updates in the field of MBS particularly VSG in adolescents. RECENT FINDINGS MBS is recommended to treat moderate to severe obesity, especially when complicated by comorbidities. The use of VSG for weight loss is increasing among adolescents and produces similar weight loss at five years in both adolescents and adults. The physiologic mechanisms causing weight loss after VSG are multifactorial and still being investigated. The complication rate after VSG ranges between 0 and 17.5%. SUMMARY VSG appears to be a well-tolerated and effective procedure in adolescents. However, it continues to be underutilized despite the increasing prevalence of moderate to severe obesity in adolescents. It is thus important to educate providers regarding its benefits and safety profile.
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Affiliation(s)
- Vibha Singhal
- Pediatric Endocrinology, Massachusetts General Hospital for Children
- Neuroendocrine Unit, Massachusetts General Hospital
- MGH Weight Center
| | | | - Madhusmita Misra
- Pediatric Endocrinology, Massachusetts General Hospital for Children
- Neuroendocrine Unit, Massachusetts General Hospital
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Pontiroli AE, Ceriani V, Tagliabue E, Zakaria AS, Veronelli A, Folli F, Zanoni I. Bariatric surgery, compared to medical treatment, reduces morbidity at all ages but does not reduce mortality in patients aged < 43 years, especially if diabetes mellitus is present: a post hoc analysis of two retrospective cohort studies. Acta Diabetol 2020; 57:323-333. [PMID: 31598798 DOI: 10.1007/s00592-019-01433-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery (BS) reduces long-term mortality in comparison with medical treatment of obesity. Some studies indicate that this effect is significant for patients above mean age in different cohorts, but not for younger patients. These findings raise the question whether morbid obese patients should undergo BS as soon as possible, or whether patients might undergo surgery later in their life. METHODS We performed a post hoc analysis of two studies; we evaluated surgery-related long-term mortality in: (1) the whole cohort [857 surgery patients (163 diabetes) vs. 2086 controls (512 diabetes)]; (2) patients above mean age [> 43 years, 427 surgery patients (133 diabetes) vs. 1054 controls (392 diabetes)]; (3) patients below mean age [≤ 43 years, 432 surgery patients (30 diabetes) vs. 1032 controls (120 diabetes]. Then, we analyzed age-related long-term mortality in the whole cohort, as well as in surgery patients and in controls. Finally, we analyzed incident diseases (diabetes, cardiovascular disease, and cancer) as a function of surgery versus no-surgery and of mean age. RESULTS Surgery patients, compared with controls receiving standard medical/dietary treatment, had reduced mortality in the whole cohort (HR = 0.45, 95% CI 0.33-0.62, p = 0.001) and in the study group aged > 43 years (HR = 0.39, 95% CI 0.28-0.56, p = 0.001), but not in the study group aged ≤ 43 years (HR = 0.87, 95% CI 0.42-1.80, p = 0.711). Reduced mortality was observed in non-diabetic and diabetic patients aged > 43 years (HR = 0.37, 95% CI 0.23-0.62, p = 0.001 and HR = 0.45, 95% CI 0.27-0.74, p = 0.002, respectively) who underwent bariatric surgery. In contrast, in patients aged ≤ 43 years, no significant protective effect of bariatric surgery appeared in non-diabetic patients (HR = 0.64, 95% CI 0.24-1.71, p = 0.371), and mortality increased, almost significantly, in diabetic patients aged < 43 years (HR = 2.87, 95% CI 0.96-8.56, p = 0.058), and even more in diabetic patients aged 33-43 years; HR = 4.99, 95% CI 1.18-21.09, p = 0.029). As expected, age-related mortality was increased in the whole cohort (HR = 7.23, 95% CI 5.14-10.17, p = 0.001), in non-diabetic and diabetic controls (HR = 8.55, 95% CI 5.77-12.68, p = 0.001, and HR = 3.76, 95% CI 1.97-7.18, p = 0.001, respectively). The effect of aging was slightly reduced in surgery patients (HR = 3.76, 95% CI 1.87-7.58, p = 0.001), while it was not significant in diabetic surgery patients (HR = 0.70, 95% CI 0.26-1.90, p = 0.88), further emphasizing that diabetes per se has a strong negative effect on survival, also with concomitant bariatric surgery. In a supplementary analysis, HRs did not change when surgery and control parents were matched for the presence of diabetes. Incident diseases (cardiovascular, diabetes, and cancer) were less frequent in surgery than in control patients, irrespective of age. CONCLUSION Bariatric surgery reduces long-term mortality in comparison with medical treatment when performed in patients aged > 43 years, but not in younger patients, where it is neutral or could even increase mortality; reduction in morbidity occurs at any age.
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Affiliation(s)
- Antonio E Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
| | | | | | | | | | - Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
- ASST Santi Paolo e Carlo, Milan, Italy.
| | - Ivan Zanoni
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
- Università degli Studi di Milano Bicocca, Milan, Italy
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Ogle SB, Inge TH, Campbell EG. Comment on: Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity. Surg Obes Relat Dis 2020; 16:419-421. [PMID: 32007434 DOI: 10.1016/j.soard.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah B Ogle
- University of Colorado, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Thomas H Inge
- University of Colorado, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Eric G Campbell
- University of Colorado, Denver, Colorado; Center for Bioethics and Humanities, University of Colorado, Denver, Colorado
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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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Moore J, Haemer M, Mirza N, Z Weatherall Y, Han J, Mangarelli C, Hawkins MJ, Xanthakos S, Siegel R. Pilot Testing of a Patient Decision Aid for Adolescents with Severe Obesity in US Pediatric Weight Management Programs within the COMPASS Network. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1776. [PMID: 31137491 PMCID: PMC6572315 DOI: 10.3390/ijerph16101776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
Abstract
Shared decision-making (SDM) is a best practice for delivering high-quality, patient-centered care when there are multiple options from which to choose. A patient decision aid (PDA) to promote SDM for the treatment of adolescent severe obesity was piloted among 12-17-year-olds (n = 31) from six pediatric weight management programs within the Childhood Obesity Multi Program Analysis and Study System (COMPASS). Medical providers used a brochure that described indications, risks, and benefits of intensive lifestyle management alone versus bariatric surgery plus lifestyle. Immediately after, patients/families completed a survey. Patient/family perceptions of provider effort to promote understanding of health issues, to listen to what mattered most to them, and to include what mattered most to them in choosing next steps averaged 8.6, 8.8, and 8.7, respectively (0 = no effort, 9 = every effort). Nearly all (96%) reported knowing the risks/benefits of each treatment option and feeling clear about which risks/benefits mattered most to them. Most (93%) reported having enough support/advice to make a choice, and 89% felt sure about what the best choice was. Providers largely found the PDA to be feasible and acceptable. This pilot will guide a more rigorous study to determine the PDA's effectiveness to support decision-making for adolescent severe obesity treatment.
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Affiliation(s)
- Jaime Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Matthew Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Nazrat Mirza
- Children's National Medical Center, Washington, DC 20010, USA.
| | - Ying Z Weatherall
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
| | - Joan Han
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
- Department of Physiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA.
| | - Caren Mangarelli
- Duke Children's Healthy Lifestyles Program, Durham, NC 27705, USA.
| | | | - Stavra Xanthakos
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
| | - Robert Siegel
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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