From adolescence to young adulthood: trajectories of psychosocial health following Roux-en-Y gastric bypass

Abstract

Background Roux-en-Y gastric bypass (RYGB) in adolescence results in substantial bodyweight reduction and cardiometabolic benefits into young adulthood. Knowledge gaps remain in understanding psychosocial health. Objective Describe trajectories of weight and psychosocial health in adolescents who underwent RYGB into young adulthood. Setting Academic Pediatric Medical Center. Methods Fourteen adolescents (presurgery: mean body mass index = 59.2 ± 8.9; mean age = 16.0 ± 1.3 yr; 64.3% female) participated in 2 sequential observational studies. Height and weight were measured, and participants completed measures of weight-related quality of life (WRQOL), mental health, and adaptive functioning at presurgery and 6, 12, 18, 24, and 72+ months post-surgery. Substance use behaviors were assessed at 72+ months. Results Modeling demonstrated rapid improvement in body mass index and WROQL across post-operative year 1, followed by stabilization and modest weight regain/WRQOL decline (P < .001), with 50% remaining severely obese. Presurgery, 11 adolescents presented with symptoms outside of the normal range for ≥ 1 mental health domain. Postoperative profiles indicated either remittance (n = 5) or persistent symptomatology (n = 6: anxious/depressed, withdrawn/depressed, and/or thought problems) in young adulthood. No new incidence of mental health vulnerability occurred in young adults not already identified preoperatively. Adaptive functioning and substance use were within normal range. Conclusions Although adolescent RYGB resulted in improvement in weight and WRQOL into young adulthood, mental health trajectories were more variable, with some experiencing positive change while others experienced persistent mental health vulnerability. Research focused on larger contemporary samples using a controlled design is critical to inform targets for prevention and intervention to optimize both physical and psychosocial health outcomes in this younger patient population.

Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities

“…From a comorbidity standpoint, studies have noted an 85% to 95% remission in T2D, a 64% to 73% resolution of dyslipidemia, and a 75% remission in hypertension . Importantly, bariatric surgery improves functional mobility and reduces musculoskeletal pain , favorably alters levels of adipokines and cytokines , improves insulin sensitivity and beta‐cell function , improves kidney function and albuminuria , reduces nonalcoholic hepatic steatohepatitis , and improves weight‐related quality of life . Moreover, a high proportion of youth are able to sustain weight loss long term, which should be an expectation given the risks and invasive nature of the procedure .…”

“…It is a life‐altering procedure that requires patients to have decisional capacity, which many adolescents have not yet developed. Further, the risks of surgery are not inconsequential and may include micronutrient deficiencies, some of which may not be fully prevented by supplementation; the possibility of future abdominal procedures; higher rates of fracture; a potentially higher incidence of suicide and nonfatal self‐harm (adult data only); excess skin due to weight loss that may require additional surgery for removal; and a tendency for increased alcohol abuse . Ongoing studies will continue to evaluate the perioperative and long‐term risks and benefits of bariatric surgery in adolescents.…”

Adolescent bariatric surgery: a qualitative exploratory study of US patient perspectives

“…In the United States, the Teen‐LABS longitudinal study of 242 adolescents who underwent bariatric surgery at five centres shows a 3‐year mean weight loss of 27%, remission of type 2 diabetes in 95% of participants, high remission rates for other serious obesity comorbidities and low rates of short‐term complications . A longitudinal observational study of post‐operative psychosocial outcomes for 14 adolescents from the same cohort at five time points showed substantial initial improvement in weight‐related quality of life . Two long‐term prospective studies with adolescents undergoing laparoscopic Roux‐en‐Y gastric bypass (LRYGB) demonstrated sustained weight loss and resolution or improvements in comorbidities years after surgery .…”

Nonalcoholic Fatty Liver Disease in Children

“…The psychological effects of bariatric surgery are not to be underestimated, and there are emerging data on the impact that such operations have on patients later in adult life. 122 Therefore, weight loss is the primary treatment of pediatric NAFLD, and it appears that the method by which this is achieved does not affect the outcome. Vitamin E is the only drug treatment that may be a direct hepatic benefit, but pharmacological management of the liver is a small component of the overall care for children with the metabolic syndrome.…”