Preferential loss of central (trunk) adiposity in adolescents and young adults after laparoscopic gastric bypass.
ABSTRACT An increasing number of young people are developing severe obesity with adult-like co-morbidities and undergoing bariatric surgery. Although a number of studies have described major weight loss after bariatric surgery, none have examined the proportions of lean body and fat mass lost or the potentially more important issue of changes in regional fat mass distribution after laparoscopic gastric bypass surgery.
Five morbidly obese females (mean age 18) were evaluated by standard anthropometric measures and dual energy x-ray absorptiometry at baseline and 1 year after bariatric surgery. The mean and SD values for the anthropometric and dual energy x-ray absorptiometry body composition variables were calculated, and the differences were evaluated using paired t tests.
Significant body mass index and weight loss were seen in all subjects at 1 year, with the percentage of excess weight loss at 63.4%. Overall fat mass loss exceeded lean mass loss by threefold in this cohort (P <.01), demonstrating the relative sparing of lean mass. Their waist circumference also decreased significantly. Using dual energy x-ray absorptiometry analysis, the vast majority (83%) of central mass loss consisted of adipose tissue. Central fat loss significantly exceeded peripheral fat loss by 1.6-fold (P = .03).
These results have demonstrated the preferential loss of central adiposity in morbidly obese young women after 1 year of surgical weight loss and may be more informative than anthropometric measurements alone. Given the association between central adiposity and the risk of subsequent cardiovascular disease, these results are suggestive of reduced cardiac risk.
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ABSTRACT: There is no previous research or documentation of the incidence of pregnancy or pregnancy outcomes in female adolescents after undergoing bariatric surgery. Retrospective chart reviews were conducted for female patients who had bariatric surgery in our adolescent program from 2001-2007. Descriptive and clinical data were abstracted from the medical records, including data from the initial assessment and from follow-up clinic visits pre- and postoperatively. 47 adolescents (age <19 years) underwent Roux-en-Y gastric bypass (RYGBP). 7 pregnancies occurred in 6 Caucasian females and resulted in 6 reported healthy term deliveries (1 pending). 6 of the 7 pregnancies were conceived between 10 and 22 months following surgery. In this small cohort of adolescent females, the pregnancy rate was 12.8%. The program pregnancy rate for adolescent females in this cohort was greater than anticipated, compared with national pregnancy rates for age and race-matched females in the USA. Risk factors that may contribute to an increased incidence of adolescent pregnancy in this unique bariatric population are unclear, but may include poor adherence to contraceptive therapy and psychosocial factors. Further research is required to define risk factors, improve adherence to contraceptive therapy, and encourage postponement of pregnancy after surgery.Obesity Surgery 07/2007; 17(7):873-7. DOI:10.1007/s11695-007-9162-7 · 3.74 Impact Factor
- Obesity Management 06/2008; 4(3):111-116. DOI:10.1089/obe.2008.0165
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ABSTRACT: Pediatric obesity is a growing problem affecting the health of our youth. We sought to identify the barriers to pediatric bariatric referral at a tertiary referral center. We performed a survey of pediatricians and family practitioners at a single institution to assess their perspectives on pediatric obesity. A total of 61 physicians completed the survey (response rate 46%). All believed pediatric obesity is a major problem, and 82.0% noted an increase in the incidence during a mean period of 15 years (range 3-25). Of the 61 physicians, 88.5% used nonoperative weight loss techniques, with only 1.8% reporting satisfactory results. However, 42.6% had referred a patient (adult or pediatric) for a bariatric procedure, of whom 84.6% were satisfied with the operative outcomes. Despite the high satisfaction with bariatric procedures, 88.5% would be unlikely or would never refer a child for a bariatric procedure, and 44.3% would be somewhat or very likely to refer an adolescent. Physicians caring for children recognize the growing problem of childhood and adolescent obesity. Despite the poor outcomes with nonoperative methods and the high satisfaction with the outcomes of bariatric procedures, physicians are still reluctant to refer children and adolescents for surgical weight loss procedures.Surgery for Obesity and Related Diseases 10/2008; 5(1):88-93. DOI:10.1016/j.soard.2008.08.023 · 4.94 Impact Factor