Pre-surgical Weight Loss Predicts Post-surgical Weight Loss Trajectories in Adolescents Enrolled in a Bariatric Program
- 47 Downloads
Adolescent obesity is markedly increasing worldwide and bariatric surgery is emerging as an effective treatment option. However, a subset of patients fails to achieve significant weight loss or show post-surgical weight regain. Efforts have been made to identify different post-surgical weight trajectories and their possible predictors. Furthermore, the role of pre-surgical intervention programs in optimizing post-surgical results has been a subject of debate.
This study aimed to evaluate the impact of a 3-month lifestyle-oriented pre-surgical program for adolescent candidates for bariatric surgery on pre-surgical weight loss (body mass index (BMI) on completion − BMI at admission), and to identify predictors of different post-surgical weight loss trajectories.
Forty-eight adolescent bariatric surgery candidates were enrolled in a lifestyle- and behavior-oriented bariatric program consisting of a 3-month pre-surgical outpatient intervention and a 6-month post-surgical follow-up.
Mean BMI decreased by 1.82 points (SD = 1.83) during the program’s pre-surgical intervention phase, a 3.8% average drop in participants’ BMI; post-surgical weight loss trajectories were significantly associated in a curvilinear model with pre-surgical weight loss; optimal post-surgical results were associated with moderate pre-surgical weight loss, and inversely associated with maternal history of obesity, early-life weight loss attempts, and comorbid learning disorders.
Moderate weight loss in a pre-surgical lifestyle-oriented intervention program predicts optimal post-surgical weight loss. Additionally, by assessing risk factors and pre-surgical weight loss patterns, it may be possible to identify sub-populations of adolescents undergoing bariatric surgery at risk of achieving sub-optimal long-term results.
KeywordsBariatric surgery Laparoscopic sleeve gastrectomy (LSG) Adolescents Pre-surgical Program Intervention BMI Prediction Trajectory Obese Lifestyle
We acknowledge all team members working at the bariatric clinic at Schneider Children’s Medical Center of Israel.
This research was conducted without funding.
Compliance with Ethical Standards
The current study received Institutional Review Board approval.
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
Statement of Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 9.Mechanick JI et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl 1):S1–27.CrossRefGoogle Scholar
- 11.Courcoulas AP et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.Google Scholar
- 25.Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery—a randomized clinical trial. Surg Obes Relat Dis. 12:180–7.Google Scholar
- 34.Fennig S, Brunstein-Klomek A, Sasson A, et al. Feasibility of a dual evaluation/intervention program for morbidly obese adolescents. Isr J Psychiatry Relat Sci. 2015;52:107–12.Google Scholar
- 35.Cooper Z, Fairburn CG, Hawker DM. Cognitive-behavioral treatment of obesity: a clinician’s guide. New York: Guilford Press; 2003.Google Scholar
- 36.Dr. Vered Ezra. Guidelines for performing bariatric surgery in adolescents under the age of 18. Israeli Ministry of Health website (2017). Available at: https://www.health.gov.il/hozer/mr27_2017.pdf. (Accessed 1st June 2018)
- 37.Wu, J. Beck Depression Inventory-Second Edition. The National Child Traumatic Stress Network (2017). Available at: https://www.nctsn.org/measures/beck-depression-inventory-second-edition. (Accessed 13th Sept 2018)
- 44.Krimpuri RD, Yokley JM, Seeholzer EL, et al. Qualifying for bariatric surgery: is preoperative weight loss a reliable predictor of postoperative weight loss? Surg Obes Relat Dis. 2018;14:60–4.Google Scholar