Kajsa Järvholm

Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study

Background Severe obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are limited, while short-term outcomes of adolescent bariatric surgery are promising. This study aimed to report 5-year outcomes following Roux-en-Y gastric bypass (RYGB) in adolescents, compared with conservatively treated adolescents and adults undergoing RYGB. Methods A nationwide prospective non-randomised controlled study of adolescents (13–18 years) with severe obesity undergoing RYGB, a matched adolescent control group undergoing conservative treatment, and an adult comparison group undergoing RYGB. The primary outcome measure was change in weight over 5 years. Multilevel mixed-effect regression models were used to assess longitudinal changes. Healthcare usage was analysed with linear regression together with nonparametric bootstrapping. Findings Eighty-one adolescents with baseline age 16·5 years (SD 1·2), weight 132·8 kg (SD 22·1) and body mass index (BMI) 45·5 kg/m2 (SD 6·1) underwent RYGB. Five-year weight change was −36·8 kg (95% CI −40·9 to −32·8) resulting in a BMI reduction of 13·1 kg/m2, although weight loss <10% occurred in 11%. Comorbidities and cardiovascular risk factors resolved in 74–100%: type 2 diabetes (3/3), disturbed glucose homeostasis (18/21), dyslipidaemia (43/52), elevated blood pressure (11/12), inflammation (hs-CRP ≥ 2 mg/L; 45/61) and elevated liver enzymes (19/19), each comparing favourably with adolescent controls at 5 years. Functional (SF-36) and obesity-specific (OP-14) quality of life improved in the adolescent RYGB group (mean difference 4·2, p=0·006 and −9·9 p=0·009). Twenty RYGB participants (25%) underwent additional abdominal surgery for complications of surgery or rapid weight loss, 72% demonstrated some nutritional deficiency, and healthcare consumption increased. Mean BMI increased in control adolescents (3·3 kg/m2, 95% CI 1·9 to 4·8), while BMI change in adults was similar to surgical adolescents (mean difference 0·8 kg/m2, 95% CI −1·1 to 2·8). Twenty adolescent controls (25%) underwent bariatric surgery within 5 years. Interpretation Adolescents with severe obesity undergoing RYGB experienced substantial weight loss over 5 years, alongside improvements in comorbidities, risk factors and quality of life. Surgical intervention was, however, associated with additional surgical interventions and nutritional deficiencies. Non-surgical treatment was associated with weight gain and 25% underwent bariatric surgery within 5 years.

Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity.

This study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass.

Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity

This study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass.

Characteristics of adolescents with poor mental health after bariatric surgery

BACKGROUND About 20% of adolescents experience substantial mental health problems after bariatric surgery. OBJECTIVES The aim of this study was to explore differences between adolescents with poor mental health (PMH) 2 years after surgery and those with average/good mental health. SETTING Three university hospitals in Sweden. METHODS Mental health and health-related quality of life were assessed in 82 of 88 adolescents (mean age: 16.8 yr, 67% female) at baseline and 1 and 2 years after laparoscopic gastric bypass. Possible associations among mental health, weight, and biochemical outcomes were explored. RESULTS Two years after surgery 16 (20%) adolescents were identified as having PMH. More symptoms of anxiety and depression and worse mental health at baseline significantly predicted PMH 2 years later. The decline in mental health for the PMH group happened mainly during the second year after surgery. Suicidal ideation was reported in 14% of the total sample 2 years postsurgery and was more frequent in the PMH group. Weight outcomes between groups were comparable at all time points, and physical health was equally improved 2 years after surgery. CONCLUSIONS Although adolescents with PMH after surgery lose as much weight and have similar improvements in physical health compared with other adolescents, special attention should be given to adolescents who report mental health problems at baseline and follow-up, especially during the second year after gastric bypass. The high prevalence of suicidal ideation in adolescents 2 years after bariatric surgery is another indication that longer follow-up is necessary.