Bariatric surgery in adolescents - Recent national trends in use and in-hospital outcome
ABSTRACT To analyze recent nationwide trends in the use of adolescent bariatric surgery and to compare early postoperative outcomes of adolescents and adults undergoing these procedures.
Analysis of national administrative data by using survey analysis techniques.
Data obtained from the Nationwide Inpatient Sample from 1996 to 2003.
Adolescents (aged <20 years) and adults undergoing bariatric surgery. Intervention Bariatric surgery.
Population-based case rates, major postoperative complications, length of hospital stay, hospital charges, and mortality.
The population-based annual adolescent bariatric case volume varied little between 1996 and 2000 but more than tripled from 2000 to 2003. Despite this trend, only 771 bariatric procedures were performed in adolescents in 2003, representing fewer than 0.7% of bariatric procedures performed nationwide. Univariate comparison with data from 2003 showed a similar in-hospital complication rate in adolescents and adults but a significantly shorter length of stay among adolescents. Although in-hospital mortality was observed in 0.2% of adults, no in-hospital deaths were observed in any adolescents.
Although procedure rates have increased recently, bariatric surgery in adolescents remains an uncommonly performed procedure. These data support efforts to align bariatric surgery programs for adolescents initially with higher volume programs for adults and to develop multicenter collaborative studies directed at defining the short- and long-term effect of bariatric surgery in morbidly obese adolescents.
- SourceAvailable from: André Scherag
[Show abstract] [Hide abstract]
- "Preliminary data in adolescents suggest that short-term outcomes for weight loss and improvement of comorbidities are similar to those observed in adults, but further studies are necessary to confirm these results and evaluate long-term outcomes [18,25-28]. Early evidence of safety and efficacy exists for two procedures (adjustable gastric band, Roux-en-Y gastric bypass (RYGB)) [15,29-31]. In principle, the group of adolescent patients with extreme obesity may be particularly vulnerable to long-term complications of surgery; on the other hand the group could potentially maximally benefit via for example enhanced integration into the job market and reduction of social isolation. "
ABSTRACT: Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI >= 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system.We have initiated the project "Medical and psychosocial implications of adolescents with extreme obesity - acceptance and effects of structured care, short: 'Youths with Extreme Obesity Study (YES)'", which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to elucidate medical and psychosocial outcomes. Our aim is to evaluate realistic treatment options. Therefore inclusion and exclusion criteria are minimized.We will recruit adolescents (age range 14--21 years) with extreme obesity (BMI >= 35 kg/m2) (extreme group) within 24 months (120 per centre, 5 centres) as well as obese adolescents being at risk for developing extreme obesity (BMI >= 30 -- 34.9 kg/m2) (at risk group). Follow-up evalutations will be performed biannually after inclusion and is planned to be extended in case of additional funding. In sum, we aim at establishing evaluated health care structures for extremely obese adolescents. The results of YES will be of importance for a frequently neglected group of individuals, for whom current medicine has little to offer in terms of structured access to empirically evaluated therapeutic programs. Thus, the results will be both a help for the adolescents within the study and for others in the future given that the trial will lead to a positive finding. Moreover, it will help practitioners and therapists to deal with this neglected group of individuals.Trial registrationProject registration numbers for each subproject: 1.) ClinicalTrials.gov: NCT01625325, NCT01703273, NCT01662271, NCT01632098; 2.) Germanctr.de: DRKS00004172, DRKS00004195, DRKS00004198, DRKS00004197.BMC Public Health 08/2013; 13(1):789. DOI:10.1186/1471-2458-13-789 · 2.26 Impact Factor
[Show abstract] [Hide abstract]
- "While it is known that weight reduction associated with anorexia nervosa and bariatric surgery leads to bone loss , , it is increasingly recognized that additional pathways contribute to the loss of bone resulting from altered nutritional status. Indeed, studies post bariatric surgery have reported that weight accounted for as little as 14% of the loss of bone mineral content, indicating a significant contribution by non-weight bearing factors . "
ABSTRACT: Gastrointestinal peptides are increasingly being linked to processes controlling the maintenance of bone mass. Peptide YY (PYY), a gut-derived satiety peptide of the neuropeptide Y family, is upregulated in some states that also display low bone mass. Importantly, PYY has high affinity for Y-receptors, particularly Y1R and Y2R, which are known to regulate bone mass. Anorexic conditions and bariatric surgery for obesity influence circulating levels of PYY and have a negative impact on bone mass, but the precise mechanism behind this is unclear. We thus examined whether alterations in PYY expression affect bone mass. Bone microstructure and cellular activity were analyzed in germline PYY knockout and conditional adult-onset PYY over-expressing mice at lumbar and femoral sites using histomorphometry and micro-computed tomography. PYY displayed a negative relationship with osteoblast activity. Male and female PYY knockout mice showed enhanced osteoblast activity, with greater cancellous bone mass. Conversely, PYY over-expression lowered osteoblast activity in vivo, via a direct Y1 receptor mediated mechanism involving MAPK stimulation evident in vitro. In contrast to PYY knockout mice, PYY over expression also altered bone resorption, as indicated by greater osteoclast surface, despite the lack of Y-receptor expression in osteoclastic cells. While evident in both sexes, cellular changes were generally more pronounced in females. These data demonstrate that the gut peptide PYY is critical for the control of bone remodeling. This regulatory axis from the intestine to bone has the potential to contribute to the marked bone loss observed in situations of extreme weight loss and higher circulating PYY levels, such as anorexia and bariatric obesity surgery, and may be important in the maintenance of bone mass in the general population.PLoS ONE 07/2012; 7(7):e40038. DOI:10.1371/journal.pone.0040038 · 3.23 Impact Factor
- "Bariatric surgery procedures specifically aimed at assisting with weight loss are becoming more popular in adolescents . A review of the literature did not identify any studies evaluating mind-body interventions specifically in pediatric bariatric surgery patients, but research supports the use of such interventions to assist children perioperatively  . "
Article: Integrative approach to obesity.[Show abstract] [Hide abstract]
ABSTRACT: Integrative medicine blends conventional medicine with carefully evaluated complementary therapies and considers all elements of a patient's lifestyle (physical, mental, spiritual). Integrative medicine therapies and philosophies have characteristics similar to those of successful treatment programs for pediatric obesity. This article defines pediatric obesity and explores those similarities in more detail. It also updates the practitioner on selected integrative approaches as they relate to prevention and treatment of pediatric obesity.Pediatric Clinics of North America 01/2008; 54(6):969-81; xi. DOI:10.1016/j.pcl.2007.10.006 · 2.12 Impact Factor