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Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS).

Journal article
Authors Torsten Olbers
Eva Gronowitz
Malin Werling
Staffan Mårild
C-E Flodmark
M Peltonen
Gunnar Göthberg
Jon Karlsson
K Ekbom
Lars Sjöström
Jovanna Dahlgren
Hans Lönroth
Peter Friberg
C Marcus
Published in International journal of obesity
Volume 36
Issue 11
Pages 1388-1395
ISSN 1476-5497
Publication year 2012
Published at Institute of Medicine
Institute of Clinical Sciences, Department of Gastrosurgical Research and Education
Institute of Clinical Sciences, Department of Pediatrics
Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences
Pages 1388-1395
Language en
Links dx.doi.org/10.1038/ijo.2012.160
Keywords adolescent; bariatric; surgery; gastric bypass
Subject categories Gastroenterology and Hepatology

Abstract

CONTEXT:The prevalence of obesity among adolescents has increased and we lack effective treatments.OBJECTIVE:To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care.DESIGN, SETTING AND PATIENTS:Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m(-2) undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care.MAIN OUTCOME MEASUREMENTS:Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group.RESULTS:Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5±6.1 (mean ±s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l(-1)) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients.CONCLUSIONS:Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.International Journal of Obesity advance online publication, 25 September 2012; doi:10.1038/ijo.2012.160.

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