Vidmar Alaina P, Vu My H, Martin Matthew J, Kim Aimee G, Abel Stuart, Weitzner Madeleine, Muñoz Cynthia E, Kim Ahlee, Samakar Kamran
Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Los Angeles, USA.
Children's Hospital Los Angeles and The Saban Research Institute Biostatistics Core, Los Angeles, USA.
Obes Surg. 2025 Feb;35(2):406-418. doi: 10.1007/s11695-024-07658-8. Epub 2025 Jan 11.
Bariatric surgery is the most effective intervention for severe pediatric obesity, but a subset of youth experience suboptimal weight loss and/or recurrent weight gain. Early re-initiation of obesity pharmacotherapy postoperatively may improve outcomes, though this has not been evaluated in pediatric populations.
A retrospective cohort study at a tertiary care children's hospital evaluated the safety and efficacy of reintroducing obesity pharmacotherapy within six weeks after laparoscopic sleeve gastrectomy (LSG). Youth were offered obesity pharmacotherapy reinitiation at their 2-week postoperative visit. The study compared outcomes between 25 youth who chose early obesity pharmacotherapy reinitiation and 21 who received standard care without restarting medication. Primary outcomes included weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions.
Between November 2023 and July 2024, 53 youth had surgical consults, and 46 (86% conversion rate; mean age 16.5 ± 1.9 years, mean BMI 53 ± 9.7 kg/m; 70% (32/46) female, 80% (37/46) Hispanic, 87% (40/46) publicly insured) underwent LSG, with 93% (43/46) using obesity pharmacotherapy preoperatively. Mixed-effects multivariate regression, adjusting for baseline BMI, age, and sex, revealed that early reinitiation (5.1 weeks [IQR 3.7, 8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6 months compared to standard care, with no significant differences in complications or readmissions. At 6 months, the mean differences were: %BMI: -6.5% (95% CI: -9.13, -3.86), p < 0.001; %TWL: -5.9% (95% CI: -8.52, -3.25), p < 0.001; %EWL: Reinitiators: -45.5% vs. standard care: -39.4%; mean difference: -8.2% (95% CI: -14.69, -1.63), p < 0.001. Early reinitiation also resulted in a significant reduction in emotional overeating at 3 and 6 months compared to standard care, with mean differences of -2.5 points (95% CI: -3.29, -1.76), p < 0.001, and -3.5 points (95% CI: -4.38, -2.69), p < 0.001, respectively on self-reported eating behavior questionnaires.
Early obesity pharmacotherapy reinitiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates.
减肥手术是治疗重度小儿肥胖最有效的干预措施，但有一部分青少年体重减轻不理想和/或体重反复增加。术后早期重新开始肥胖药物治疗可能会改善治疗效果，不过这尚未在儿科人群中得到评估。
在一家三级儿童专科医院进行的一项回顾性队列研究，评估了腹腔镜袖状胃切除术（LSG）后六周内重新引入肥胖药物治疗的安全性和有效性。青少年在术后2周复诊时可选择重新开始肥胖药物治疗。该研究比较了25名选择早期重新开始肥胖药物治疗的青少年与21名接受标准护理且未重新用药的青少年的治疗效果。主要结局包括体重变化轨迹、饮食行为、并发症、再入院率和再次手术率，采用独立t检验、卡方检验和逻辑回归进行分析。
在2023年11月至2024年7月期间，53名青少年接受了手术咨询，46名（转化率86%；平均年龄16.5±1.9岁，平均BMI 53±9.7kg/m²；70%（32/46）为女性，80%（37/46）为西班牙裔，87%（40/46）有公共保险）接受了LSG，其中93%（43/46）术前使用了肥胖药物治疗。在对基线BMI、年龄和性别进行调整的混合效应多变量回归分析中发现，与标准护理相比，早期重新开始治疗（5.1周[四分位间距3.7，8.4]）在3个月和6个月时显著降低了BMI、BMI百分比、总体重减轻百分比（TWL）和超重减轻百分比（EWL），并发症或再入院率无显著差异。在6个月时，平均差异为：BMI百分比：-6.5%（95%CI：-9.13，-3.86），p<0.001；TWL百分比：-5.9%（95%CI：-8.52，-3.25），p<0.001；EWL百分比：重新开始治疗组：-45.5%，标准护理组：-39.4%；平均差异：-8.2%（95%CI：-14.69，-1.63），p<0.001。与标准护理相比，早期重新开始治疗在3个月和6个月时还显著减少了情绪化暴饮暴食，自我报告的饮食行为问卷上的平均差异分别为-2.5分（95%CI：-3.29，-1.76），p<0.001，以及-3.5分（95%CI：-4.38，-2.69），p<0.001。
LSG术后早期重新开始肥胖药物治疗是安全的，耐受性良好，可改善体重结局，且不会对并发症或再入院率产生负面影响。
