National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

Griggs, Cornelia L.; Perez, Numa P.; Goldstone, Robert N.; Kelleher, Cassandra M.; Chang, David C.; Stanford, Fatima Cody; Pratt, Janey

doi:10.1001/jamapediatrics.2018.3030

Cited by 82 publications

(23 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adolescents had a better response to SG than adults, which is consistent with previous studies (22,23). This is encouraging and supportive of the current trend of more frequent SG, with its reduced complexity and lower post-surgical prevalence of micronutrient deficiencies than RYGB, particularly in adolescents (18).…”

Section: Discussionsupporting

confidence: 88%

“…A recent study showed greater resolution of T2D and HTN in adolescents as compared to adults after Roux-en-Y gastric bypass (RYGB) suggesting a benefit of early intervention (17). However, data comparing long-term outcomes following sleeve gastrectomy (SG), the most commonly performed MBS is not available (18). Moreover, data comparing outcomes of RYGB and SG across age are lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objective: We sought to compare the short and long-term outcomes of MBS in adolescents vs. adults who have undergone a Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG).Design: Retrospective cohort study.Setting: Single tertiary care academic referral center.Participants: One hundred fifty adolescent (≤21-years) and adult (>21-years) subjects with severe obesity between 15 and 70 years of age who underwent RYGB or SG.Outcomes: Metabolic parameters, weight and height measures were obtained pre-and post-surgery (at 3 and 6 months, and then annually for 4 years).Results: Median pre-surgical body mass index (BMI) was higher in adolescents (n = 76) vs. adults (n = 74): 50 (45-57) vs. 44 (40-51) kg/m 2 (p < 0.0001). However, obesity related complications were greater in adults vs. adolescents: 66 vs. 21% had hypertension, 68 vs. 28% had dyslipidemia, and 42 vs. 21% had type 2 diabetes mellitus (all p < 0.010). % BMI reduction and % weight loss (WL) were greater in adolescents vs. adults at all time points (p < 0.050). %WL was higher in adolescents who underwent SG at each time point (p < 0.050), and trended higher among adolescents who underwent RYGB (p = 0.060), compared to adults with the respective procedure. Follow-up data showed greater resolution of type 2 diabetes and hypertension in adolescents than adults (87.5 vs. 54.8%; p = 0.04, and 68.7 vs. 35.4%; p = 0.040).Conclusion: Adolescents compared to adults had greater reductions in BMI and weight, even at 4 years, and greater resolution of type 2 diabetes and hypertension. Earlier intervention in the treatment of severe obesity with MBS may lead to better outcomes.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Teen-LABS and associated ancillaries provide the most comprehensive prospectively collected data characterizing adolescent Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) outcomes, enhanced by ancillary inclusion of nonsurgical comparators. However, consistent with bariatric enrollment trends (2008-2012), 49 participants were predominantly White, female, and underwent RYGB. Understanding whether these findings generalize to females of other race/ethnic groups is important future research given known disparities for adverse sexual health outcomes.…”

Section: Discussionsupporting

confidence: 53%

Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery

Zeller

Brown

Reiter‐Purtill

et al. 2019

Surgery for Obesity and Related Diseases

View full text Add to dashboard Cite

Background: Adolescents females with severe obesity are less likely to be sexually active, yet those who are engage in risky sexual behaviors. Objectives: To examine patterns and predictors of sexual-risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did/did not undergo bariatric surgery across 4 years. Setting: Five academic medical centers Methods: Utilizing a prospective observational controlled design, female adolescents undergoing bariatric surgery (n = 111;M age =16.95±1.44 years; Body Mass Index: M BMI =50.99±8.42, 63.1% White) and nonsurgical comparators (n = 68; M age =16.18±1.36 years; M BMI =46.47±5.83, 55.9% White) completed the Sexual Activities and Attitudes Questionnaire at pre-surgery/baseline, 24and 48-month follow-up, with 83 surgical females (M BMI =39.27±10.08) and 49 nonsurgical females (M BMI =48.56±9.84) participating at 48-months.

show abstract

“…According to the most recently available data from the NHANES, the prevalence of severe obesity from 2015 to 2016 was 1.9% among children and adolescents 2 to 19 years old, with 4.5% of adolescents age 16-19 years old affected by severe obesity (1). While strides have been made toward encouraging the utilization of metabolic and bariatric surgery (MBS) for pediatric patients with severe obesity, with definitive guidance from organizations such as the American Academy of Pediatrics (AAP) and the American Society of Metabolic and Bariatric Surgery (ASMBS) (14)(15)(16)(17), there remains a gap in care for patients who have been refractory to lifestyle modifications but do not meet criteria for MBS.…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

et al. 2020

Self Cite

View full text Add to dashboard Cite

Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m 2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ∼6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m 2 , respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should Czepiel et al. Pharmacotherapy for Weight Reduction in Pediatrics be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.

show abstract

National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

Cited by 82 publications

References 7 publications

Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

Contact Info

Product

Resources

About