Department of Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petach-Tikwa, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Obes Surg. 2019 Apr;29(4):1154-1163. doi: 10.1007/s11695-018-03649-8.
Adolescent obesity is markedly increasing worldwide and bariatric surgery is emerging as an effective treatment option. However, a subset of patients fails to achieve significant weight loss or show post-surgical weight regain. Efforts have been made to identify different post-surgical weight trajectories and their possible predictors. Furthermore, the role of pre-surgical intervention programs in optimizing post-surgical results has been a subject of debate.
This study aimed to evaluate the impact of a 3-month lifestyle-oriented pre-surgical program for adolescent candidates for bariatric surgery on pre-surgical weight loss (body mass index (BMI) on completion - BMI at admission), and to identify predictors of different post-surgical weight loss trajectories.
Forty-eight adolescent bariatric surgery candidates were enrolled in a lifestyle- and behavior-oriented bariatric program consisting of a 3-month pre-surgical outpatient intervention and a 6-month post-surgical follow-up.
Mean BMI decreased by 1.82 points (SD = 1.83) during the program's pre-surgical intervention phase, a 3.8% average drop in participants' BMI; post-surgical weight loss trajectories were significantly associated in a curvilinear model with pre-surgical weight loss; optimal post-surgical results were associated with moderate pre-surgical weight loss, and inversely associated with maternal history of obesity, early-life weight loss attempts, and comorbid learning disorders.
Moderate weight loss in a pre-surgical lifestyle-oriented intervention program predicts optimal post-surgical weight loss. Additionally, by assessing risk factors and pre-surgical weight loss patterns, it may be possible to identify sub-populations of adolescents undergoing bariatric surgery at risk of achieving sub-optimal long-term results.
青少年肥胖症在全球范围内显著增加，减重手术作为一种有效的治疗选择正在出现。然而，有一部分患者未能实现显著的体重减轻，或出现术后体重反弹。人们已经努力确定不同的术后体重轨迹及其可能的预测因素。此外，术前干预方案在优化术后结果方面的作用一直是争论的主题。
本研究旨在评估 3 个月生活方式导向的青少年减重手术候选者术前方案对术前体重减轻（完成时的体重指数（BMI）-入院时的 BMI）的影响，并确定不同术后体重减轻轨迹的预测因素。
48 名青少年减重手术候选者参加了一个生活方式和行为导向的减重计划，包括 3 个月的术前门诊干预和 6 个月的术后随访。
在该方案的术前干预阶段，参与者的平均 BMI 下降了 1.82 点（标准差 = 1.83），即参与者 BMI 的平均下降了 3.8%；术后体重减轻轨迹与术前体重减轻呈显著曲线关系；最佳的术后结果与适度的术前体重减轻相关，与母亲肥胖史、早期生命体重减轻尝试和合并学习障碍呈负相关。
术前生活方式导向干预方案中的适度体重减轻可预测最佳的术后体重减轻。此外，通过评估风险因素和术前体重减轻模式，可能可以识别接受减重手术的青少年亚群，这些亚群存在获得不理想的长期结果的风险。
