The National Institute of Clinical Excellence states that bariatric surgery may be considered for adolescents with severe obesity in 'exceptional circumstances'. However, it is not clear what is deemed to be exceptional, and there is a lack of long-term outcomes data or research, which would inform patient selection. This is an in-depth qualitative study involving five adolescents who had previously undergone bariatric surgery (between 1 and 3 years postoperatively) and four who were being assessed for the treatment. All patients were from one tertiary NHS weight management service offering bariatric surgery to adolescents. Participants were interviewed to explore how young people decide whether bariatric surgery is an appropriate intervention for them. Of the nine adolescents recruited, four were male and five female, aged between 17 and 20 years at the time of interview. Participants who had already undergone surgery did so between the ages of 16 and 18. The data were analysed using interpretative phenomenological analysis, and key themes were identified, such as (i) wanting a different future, (ii) experiences of uncertainty, (iii) managing the dilemmas and (iv) surgery as the last resort. The findings suggest that young people are prepared to accept a surgical solution for obesity despite numerous dilemmas. Young people choose this intervention as a way of 'normalizing' when they perceive there is nothing better available. It is argued that these findings may have implications for the counselling of young people living with overweight and obesity and for government policy.

The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.

A predominant theme of 'uncertainty' around adolescent bariatric surgery emerged from the interviews. In the absence of empirical data, professionals bracket away this uncertainty by a variety of means, including the acceptance of surgery as inevitable. This study has implications for the effective counselling of adolescents and their families around bariatric surgery. Evidence suggests that bariatric surgery is increasingly being offered to adolescents with severe obesity despite the lack of long-term outcome data or research to guide patient selection. This is a qualitative study in which nine clinicians were interviewed to investigate the process of decision-making around adolescent bariatric surgery. The interviews revealed a pervasive 'uncertainty', with sources of uncertainty relating to (i) the lack of research in this area, (ii) the perception of bariatric surgery as a treatment option unlike others, (iii) the view that adolescence is a complex developmental period and (iv) the perception that bariatric in adolescents is controversial to the public. Professionals manage this uncertainty in a variety of ways, which are described. It is argued here that shedding light on this process of professional decision-making has implications for policy and practice and for the counselling of patients considering these sorts of treatments.

Abstract:Objectives: The paediatric and adolescent clinical psychology service at UCLH provides age-appropriate services to young people under the care of a hospital consultant up to nineteen years old. This short report describes how young people and parents experience what we provide as a systemic paediatric psychology team. Results: 44/79 families discharged in the previous year were contacted by phone. The majority of young people and parents were happy being called to discuss the referral before being offered an appointment and liked the way in which the psychologist worked with the family. The majority of young people and parents reported their situation had improved as a result of the work offered by the psychology team. Negative aspects of the experience reflected the realities of service driven constraints including having to travel a long distance for the appointment, lack of rooms and having to be discharged at 19 years of age. Method Conclusions:Service user feedback is imperative to providing a high standard of care. This study highlighted positive experiences of a systemic service and indicated areas for future improvement that we are attempting to address 4