Severe Obesity In Adolescents Research Articles

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

ObjectiveTo assess subclinical kidney injury in severely obese adolescents by measuring biomarkers of early kidney disease and to assess changes in the levels of these biomarkers following bariatric procedure.Methods22 severely obese adolescents undergoing bariatric surgery with no microalbuminuria and normal kidney function were selected. Urinary NGAL, IL-18, and KIM-1 were measured at baseline, 6, and 12 months post-operatively. Biomarker levels were compared to 44 age-gender-matched lean controls.ResultsObese subjects had a mean baseline BMI of 48 kg/m2 that decreased by 34% at 1 year follow-up. Urine NGAL, IL-18 and KIM-1 were significantly elevated in obese compared to lean controls at baseline. The obese cohort had a further significant increase in NGAL and KIM-1 at 6 months, followed by decline at 1 year. The overall change in levels of all three biomarkers through 1 year after surgery, however, was not significant compared to baseline.ConclusionsAdolescent severe obesity is associated with increased urinary excretion of novel biomarkers of kidney injury, despite no microalbuminuria or decreased kidney function. This subclinical kidney injury persists 1 year after significant weight loss induced by bariatric surgery, suggesting that close long-term follow up of kidney status is warranted in these adolescents.

Effects of a cognitive-behavioral therapy-based immersion obesity treatment program for adolescents on weight, fitness, and cardiovascular risk factors: a pilot study.

Comprehensive, residential treatment for severe obesity in adolescents may be an alternative to bariatric surgery and more efficacious than outpatient treatment. The aim of this study was to evaluate the effects of a long-term cognitive-behavioral therapy-based immersion obesity treatment program for adolescents. Twelve obese adolescents with BMIs above the 95th percentile completed a 14- to 18-week multicomponent intervention. We observed significant improvements in BMI z-score, waist circumference, mile run time, and blood lipids. This study suggests that the tested program may be effective, at least in the short term; a randomized, controlled trial to further assess this model is warranted.

SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS.

Background: In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%. Aim : To evaluate the surgical results of severe obesity in adolescents. Methods: Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members. Results: Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30. Conclusions: Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

Bariatric surgery in obese adolescents: opportunities and challenges.

Extreme obesity is defined by the Centers for Disease Control and Prevention as a body mass index (BMI) higher than 120% of the 95th percentile for age. Four to six percent of American youths fall into this subcategory and are at increased risk for developing comorbidities, including hypertension, dyslipidemia, nonalcoholic fatty liver disease, insulin resistance, sleep apnea, and bone and joint problems. Many studies have shown that nonsurgical treatment programs do not provide significant long-term improvements in BMI in adolescents with severe obesity. In adults, bariatric (weight loss) surgery has been shown to dramatically reduce BMI and to reverse or prevent many complications of obesity; thus, bariatric surgery is being used in an attempt to reverse clinically severe obesity in adolescents. This review highlights the indications for bariatric surgery in adolescents and outlines practice guidelines for adolescent surgical weight loss programs. The authors summarize available data on the effects of adolescent weight loss surgery on metabolic comorbidities and highlight the important acute and long-term complications that must be monitored by their general pediatricians. After reading this article, the general pediatrician should be able to identify adolescents who may be candidates for weight loss surgery and have the knowledge to assist in their postoperative medical management.

Topiramate for weight reduction in adolescents with severe obesity.

Medications for use as an adjunct to lifestyle modification therapy (LSM) for severe adolescent obesity are limited. Topiramate results in weight reduction in adults with obesity, but has not been studied in adolescents. To examine the effect of topiramate plus LSM on body mass index (BMI) reduction in adolescents with severe obesity. Data for this retrospective chart review were collected from patients attending a pediatric weight management program who were treated with LSM plus topiramate for 3 months minimum. Mean BMI percent change from baseline was evaluated using t-tests. Twenty-eight patients (mean age 15.2 ± 2.5 years, mean baseline BMI 46.2 ± 10.3 kg/m(2)) were identified for inclusion. The 6-month percent change in BMI was -4.9, 95% confidence interval (-7.1, -2.8), P < .001. Topiramate with concurrent LSM was associated with clinically meaningful BMI reduction in adolescents with severe obesity. Randomized controlled clinical trials examining efficacy and safety of topiramate for severe obesity in adolescents are needed.

Pediatric severe obesity: time to establish serious treatments for a serious disease.

Pediatric severe obesity: time to establish serious treatments for a serious disease.

EPA-0664 – Bariatric surgery in severe adolescent obesity, psychopathology approach from a retrospective study of 35 clinical observations

Obesity is considered as an epidemic affecting adults, children and adolescents. An obese child become often an obese adult and early obesity is associated with increased mortality in adulthood. Medical treatments of obesity are often disappointing. Also, bariatric surgery is required for several years as a treatment of choice in adults, and more recently in adolescents. Since 2009, the pediatric team of the University Hospital of Angers offers an innovative multidisciplinary support in addition to conventional medical, the ‘obesity network’, and offers the possibility of surgery for adolescents under specific indications. The authors studied retrospectively thirty-five case of severly obese adolescents followed at the University Hospital of Angers for which bariatric surgery was considered. The objective was to determine for each folder lighting elements on the clinic and specific psychopathology of these adolescents. A first observation concerns the common paternal absence in the study cohort. It is also found long delays between parental perception of an overweight problem and the first specialist consultation. This last observation is significantly related to the presence of a paternal overweight. Weight loss is also significantly higher in the group of patients operated on the group of non-operated patients. Finally, we argued necessary psychotherapy support of these patients in their care.

Abstract MP50: The Development of Severe Obesity in Urban Girls

Introduction: Despite rising prevalence of youth-onset severe obesity, its development is poorly understood. Hypothesis: Girls who are severely obese in early adolescence will show more rapid growth between ages 7-10 and 11-14 compared with those who have normal BMI in early adolescence. The two groups’ BMI trajectories will diverge in late childhood. Methods: To estimate the prevalence and incidence of youth-onset severe obesity (BMI &gt;99 th percentile-for-age) and compare weight development between girls with severe obesity and those with healthy BMI. We examined data from participants in an accelerated longitudinal cohort study of urban girls from a single US city (n=2206; 51% African American). Data were collected annually from 2003-2004 (when participants were aged 7-10) to 2008-2009. Girls were excluded who became pregnant (n=143) or provided no weight data (n=102) in those six years. Prevalence data calculations were compared using the standard severe obesity definition as well as an alternative definition (120% of the 95 th BMI-percentile-for-age). We used unconditional latent growth curve models (LGCM) to compare the BMI development of girls who were severely obese at age 12-15 with those who had normal BMI at age 12-15. Results: Severe obesity prevalence was 4.5% at age 7-10 and 6.3% (3.6% of white girls and 8.2% of African American girls; p&lt;0.001) at age 12-15. Incident severe obesity was 0% to 1.9% annually. The alternative definition of severe obesity yielded slightly higher prevalence estimates (6.2% at age 7-10 and 9.5% age 12-15). When we compared 12-15 year-old girls with severe obesity versus healthy BMI, average body weight was already distinct 5 years earlier [16.5 kg (SD 2.2) versus 27.0 kg (SD 4.7)].The difference in average BMI between the two groups widened with each sample year. Unconditional latent growth curve models between ages 7-10 and 11-14 indicated an average increase of 0.59 kg/m 2 annually in the healthy BMI group and 2.32 kg/m 2 annually in the severe obesity group. Conclusions: Severe obesity was relatively common in urban girls, particularly African American girls, by age 7-10. Girls with severe obesity showed a nearly 4-fold rate of BMI change over 5 years, compared to girls with healthy BMI. Girls with early adolescent severe obesity already showed significantly higher BMI by age 7-10. Prevention is essential prior to age 7, with emphasis on minority populations.

The Ethical Dilemma of Adolescent Bariatric Surgery

Adolescent obesity and obesity-related conditions have risen at alarming rates in the United States, positioning childhood obesity as a major public health issue. The consequences of adolescent obesity are far-reaching and often include medical, psychosocial, emotional, and economic burdens. Traditional interventions targeted at diet and behavior modification are largely ineffective in reducing adolescent adiposity. Bariatric surgery, therefore, is gaining recognition as a means to significant and sustained weight loss in the teenage population. Given the innovative nature of this intervention and the lack of robust evidence to support its safety and efficacy in this population, few procedures are being performed on pediatric patients. Surgical weight loss in young patients with severe obesity poses a staid ethical burden to all involved. This article addresses the ethical issues of beneficence and nonmaleficence as they apply to adolescent bariatric surgery. Bariatric surgery for the treatment of severe adolescent obesity is an ethical and effective approach when performed discriminately in centers that can provide expert interprofessional support.

Two‐Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional myocardial abnormalities remains largely unknown, potentially because of its frequent association with other cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function. We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in youths with isolated severe obesity. Thirty-seven asymptomatic severely obese adolescents free of diabetes and hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate (SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (-24%) and systolic and early diastolic SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ± 0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic-diastolic coupling, an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part related to alterations in relaxation and contractility properties of subendocardial fibers.

La chirurgie bariatrique chez l’adolescent est-elle légitime ?

Current recommendations for bariatric surgery are limited to patients older than 18 years. Two studies in 2007 showed that bariatric surgery improves survival in adults. Medical management of severe obesity in adolescents is all too often ineffective. For these reasons, early surgical intervention for adolescents with morbid obesity may be expected to prevent or avoid comorbidities, decrease mortality, and improve the quality of life. Several studies have demonstrated the feasibility of adolescent bariatric surgery with morbidity comparable to that seen in adult series. The earlier the surgery, the better the result in terms of prevention or reversal of comorbid conditions. In the USA, a consensus definition of adolescents eligible for bariatric surgery specifies attainment of Tanner Stage IV of sexual maturity and achievement of 95% of axial growth. Just as in adults, bariatric surgery in adolescents requires prolonged follow-up; it is important that such surgery be performed in centers specialized in adult bariatric surgery having the necessary multidisciplinary structure.

The Application of Laparoscopic Bariatric Surgery for Treatment of Severe Obesity in Adolescents Using a Multidisciplinary Adolescent Bariatric Program

The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

DL-fenfluramine and phentermine in the treatment of severe obesity in adolescence: Robert I. Berkowitz, M.D., Stanley E. Hemsley, Jr., M.D., Christine M. Forke, B.A., Abbas F. Jawad, Ph.D., Gail B. Slap, M.D. Department of Psychiatry; The Craig-Dalsimer Program in Adolescent Medicine, Departments of Medicine and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia Child Guidance Center and The Children's Hospital

DL-fenfluramine and phentermine in the treatment of severe obesity in adolescence: Robert I. Berkowitz, M.D., Stanley E. Hemsley, Jr., M.D., Christine M. Forke, B.A., Abbas F. Jawad, Ph.D., Gail B. Slap, M.D. Department of Psychiatry; The Craig-Dalsimer Program in Adolescent Medicine, Departments of Medicine and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia Child Guidance Center and The Children's Hospital