Weight Loss In Adolescents Research Articles

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa

Lower weight has historically been equated with more severe illness in anorexia nervosa (AN). Reliance on admission weight to guide clinical concern is challenged by the rise in patients with atypical anorexia nervosa (AAN) requiring hospitalization at normal weight. We examined weight history and illness severity in 12- to 24-year-olds with AN (n = 66) and AAN (n = 50) in a randomized clinical trial, the Study of Refeeding to Optimize Inpatient Gains (www.clinicaltrials.gov; NCT02488109). Amount of weight loss was the difference between the highest historical percentage median BMI and admission; rate was the amount divided by duration (months). Unpaired t tests compared AAN and AN; multiple variable regressions examined associations between weight history variables and markers of illness severity at admission. Stepwise regression examined the explanatory value of weight and menstrual history on selected markers. Participants were 16.5 ± 2.6 years old, and 91% were of female sex. Groups did not differ by weight history or admission heart rate (HR). Eating Disorder Examination Questionnaire global scores were higher in AAN (mean 3.80 [SD 1.66] vs mean 3.00 [SD 1.66]; P = .02). Independent of admission weight, lower HR (β = -0.492 [confidence interval (CI) -0.883 to -0.100]; P = .01) was associated with faster loss; lower serum phosphorus was associated with a greater amount (β = -0.005 [CI -0.010 to 0.000]; P = .04) and longer duration (β = -0.011 [CI -0.017 to 0.005]; P = .001). Weight and menstrual history explained 28% of the variance in HR and 36% of the variance in serum phosphorus. Weight history was independently associated with markers of malnutrition in inpatients with restrictive eating disorders across a range of body weights and should be considered when assessing illness severity on hospital admission.

High school students’ use of flavored e-cigarette e-liquids for appetite control and weight loss

BackgroundAlthough weight-related reasons for smoking and vaping have been examined in adults, research in adolescents is lacking. Thus, we examined the prevalence and correlates of using flavored e-liquids for appetite control or weight loss in high school adolescents. MethodsThe analytic sample included 529 students who completed a school-based survey in Connecticut in Spring 2017 (50.6% female, 79.5% White, mean age 16.27 [SD = 1.18], range 13–19 years). Inclusion criteria were past-30-day vaping, using ≥ 1 flavored e-liquid (past month), and having non-missing data on flavored e-liquid use for appetite control and weight loss. Participants reported on sex, age, race, past-30-day vaping and smoking frequency, nicotine e-liquid use, flavored e-liquid use (e.g., tobacco, mint, fruit, candy), and flavored e-liquid use for appetite control and/or weight loss. ResultsAdolescent e-cigarette users (past 30-days) reported vaping flavored e-liquids for appetite control (13.8%) and weight loss (9.3%). Using flavored e-liquids for appetite control or weight loss, respectively, was associated with more frequent vaping (OR = 1.21; 1.21) and using more flavored e-liquids (OR = 1.33; 1.28, p-values < 0.01). Vaping candy-flavored e-liquids (OR = 1.16, p = 0.02) uniquely was associated with vaping for appetite control. ConclusionsA subset of adolescents reported using flavored e-liquids for weight-related reasons. These adolescents reported vaping more frequently than their counterparts, raising concerns about increased nicotine exposure. Research is needed to understand where adolescents learn about weight-motivated vaping (e.g., friends, social media) and whether weight-related motives promote e-cigarette initiation among e-cigarette naïve individuals or continued/escalating use among current users.

High prevalence of attention-deficit/hyperactivity disorder in adolescents with severe obesity seeking bariatric surgery.

To examine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and related post-surgical weight loss in adolescents with severe obesity seeking bariatric surgery. The study population included 84 adolescents (age 13-19years; 44 males, 40 females) with severe obesity who sought bariatric surgery at the Sheba Medical Centre in Israel during the years 2011-2017. Anthropometric and clinical data were collected from medical records. A subgroup of 20 participants filled questionnaires that evaluated ADHD-like symptoms, eating behaviours and quality of life. Data on adolescents that ultimately underwent surgery (n=45) were also obtained. The prevalence of ADHD was 28.6% in adolescents seeking bariatric surgery, much higher than that of the general adolescent population of Israel (17.1%, P<.001). There were no significant differences in reductions of weight, body mass index, body mass index standard deviation scores and body fat percent between participants with or without ADHD. In the subgroup that filled questionnaires, higher scores on ADHD-Rating Scale at baseline were associated with greater excess weight loss. The prevalence of ADHD in adolescents seeking bariatric surgery was very high. Diagnosed ADHD was not related to post-surgical weight loss, whereas baseline ADHD-related behaviour was associated with higher post-surgical weight loss.

Energy balance-related factors associating with adolescent weight loss intent: evidence from the 2017 National Youth Risk Behavior Survey

BackgroundThe purpose of this study was to examine specific energy balance-related behaviors (sedentary behaviors, physical activity, and dietary) associating with adolescent weight loss intent using data from the 2017 US Youth Risk Behavior Survey (YRBS).MethodsThis was a cross-sectional study that employed a multi-stage cluster sampling procedure to obtain a representative sample of US adolescents. The target population consisted of public and private high schoolers from grades 9 through 12. The number of sampled adolescents was 18,324 with 14,765 of the 18,324 sampled students (Mean age = 15.9 (1.3) years) submitting questionnaires with usable data (81% response rate). The outcome was intent to lose weight with specific energy-balance related behaviors examined as predictor variables. A weighted logistic regression model was employed to examine the associations between sedentary behaviors, physical activity, and dietary-related variables with weight loss intent controlling for age, sex, BMI percentile, and race/ethnicity.ResultsVariables associating with adolescent intent to lose weight included 3 or more hours of video game playing (OR = 1.15, 95%CI: 1.01–1.31, p = 0.028), achieving 60 min of physical activity daily (OR = 0.66, 95%CI: 0.59–0.73, p < 0.001), daily breakfast consumption (OR = 0.76, 95%CI: 0.67–0.87, p < 0.001) and weekly salad consumption (OR = 1.30, 95%CI: 1.12–1.52, p = 0.001).ConclusionsMeeting physical activity guidelines and regular breakfast consumption associated with lower odds of weight loss intent and video game playing and salad consumption associated with higher odds of weight loss intent in a representative sample of US adolescents. Therefore, there is a discordance between adolescent weight loss intent and the engagement in specific energy balance-related health behaviors, particularly physical activity.

The Effects Of HIIT And LIT On Weight Loss In Obesity Children/adolescents: A Systematic Review And Meta-analysis

PURPOSE: To explore the effect of high-intensity interval training and low-intensity training on weight loss in obese children and adolescents. METHODS: Search database (MEDLINE, PubMed, websites of science core database), the deadline is May 20, 2018. The screening conditions were as follows: Randomized controlled trials;Writing in English;Participants in the study were obese children/adolescents between the ages of 6 and 18 ;The intervention model is HIIT or LIT, and the training time is at least four weeks;The final results of the study should include weight (body weight), BMI, body fat ratio (% body fat), and body fat (fat weight). The risk assessment was assessed using the Jadad scale (total score of 7). RESULTS: Compared with LIT, HIIT can significantly reduce % body fat[-1.27(95%CI=-1.87,-0.67),Z=4.14(p<0.0001)] ,BMI[-0.42(95%CI=-0.83,-0.01),Z=2.00(p=0.05)] and body weight. [-0.40(95%CI=-0.73 ,-0.06),Z=2.33(p=0.02)];Comparing the EG and the CG of HIIT and LIT respectively which is found that for the body weight index, the combined statistical effect values of the two training methods were significantly different. However, LIT is better than HIIT[HIIT=-0.27(95%CI=-0.49,-0.04)][LIT=-0.94(95%CI=-1.12,-0.75)];%body fat, HIIT is better than LIT [HIIT=-0.56(95%CI=-0.84,-0.29)][LIT=-0.45(95%CI=-0.70,-0.21)] CONCLUSIONS: HIIT is more effective for obese children/adolescents than LIT. LIT is better for whole body weight loss, but HIIT is better for body fat reduction. For aerobic training, the training period and the number of times are not proportional to the weight loss effect.The subgroup analysis of low intensity training

Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults

BackgroundBariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear.MethodsWe evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts.ResultsThere was no significant difference in percent weight change between adolescents (−26%; 95% confidence interval [CI], −29 to −23) and adults (−29%; 95% CI, −31 to −27) 5 years after surgery (P=0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P=0.003). More adolescents than adults had low ferritin levels (72 of 132 patients [48%] vs. 54 of 179 patients [29%], P=0.004).ConclusionsAdolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT00474318.)

Physical Activity Improves Lipid and Weight-Loss Outcomes After Metabolic Bariatric Surgery in Adolescents with Severe Obesity.

Objective:To test the hypothesis that Physical Activity (PA) improves cardiovascular disease (CVD)-related lipids beyond that associated with weight loss in adolescents with severe obesity, post-metabolic bariatric surgery (MBS).Methods:We used objective StepWatch™ PA data from 108 participants of the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study from baseline to 3 years post-MBS. Primary outcomes included absolute change in low density lipoprotein (LDL-C) and non-high density lipoprotein (non-HDL-C) from baseline. We adjusted for baseline measurement, visit, surgical procedure, and percent change in iliac waist circumference (IWC) or body mass index (BMI) from baseline in linear regression models using generalized estimating equations. PROC TRAJ in SAS generated optimal activity trajectories based on individual step count.Results:Despite low step counts and slow cadence, differences by activity trajectory were found. Greater absolute decreases in LDL-C and non-HDL-C (−15 mg/dL [95% CI: (−28, −2)], p =0.026 and −15 mg/dL [95% CI: (−28, −1)], p = 0.035), respectively, were associated with more activity (MA). MA was associated with greater resolution of triglycerides, LDL-C and non-HDL-C dyslipidemia and with greater weight loss 3 years post-MBS.Conclusion:More activity in adolescents was associated with improvements in CVD-related lipid measures and weight loss, post-MBS.

PO-01-069 GnRH analogues: An effective pharmacological approach for the management of restrictive eating behaviors related to Gender Dysphoria in adolescents

The co-occurence of Gender Dysphoria (GD) and Anorexia Nervosa (AN) has been described in the scientific literature. While the emphasis so far has focused on the overlap in symptomatology of the two conditions, pathological eating behaviors in adolescents with GD may have a different psychopathological meaning. The main objective of the study is to conceptualize pathological eating behaviors (in particular, dieting, weight loss and intense physical activity) in adolescents with GD as a dysfunctional coping strategy used to deal with pubertal body changes. Furthermore, to describe the use of gonadotropin-releasing analogs (GnRHa) as an effective treatment option when adolescents with GD present restrictive eating behaviors. Two cases of adolescents with GD and pathological eating behaviors are presented. Both received psychological evaluations and endocrinological examinations at different times: at first admission to the GD clinic (T0) and 6 months after starting treatment with GnRHa (T1). In particular, at both times depression, anxiety, body dissatisfaction, social withdrawal, as well as suicidal risk were assessed. Regarding medical measures, Tanner stage, weigh, height, waist, body mass index (Kg/m2), Ferriman Gallwey score and hormonal levels were performed.

Recent trends of bariatric surgery in adolescent population in the state of New York

BackgroundIn the United States the percentage of adolescents with obesity has reached an alarming level of 21%. Bariatric surgery has emerged as a successful intervention in the weight loss for adolescents. ObjectiveTo compare bariatric procedures performed in adolescent and adult populations. SettingUniversity Hospital, United States. MethodsUsing the Statewide Planning and Research Cooperative System (SPARCS) database, records from the adolescent (age 12-21years) and adult populations undergoing bariatric surgery during 2005-2014 were examined. Patients’ demographics, surgery type (Roux-en-Y gastric bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), length of stay (LOS), complications and comorbidities were analyzed. ResultsThe annual adolescent bariatric cases increased from 150 in 2005 to 406 in 2014. In the adolescent population, increasing utilization trends were noted in the Hispanic population (RR=1.08, p-value<0.0001), use of Public (Medicaid or Medicare) insurance (RR=1.10, p-value=0.0003) and SG procedures (RR= 1.56, p-value <0.0001). Decreasing trends were noted in the Caucasian population (RR=0.95, p-value<0.0001), RYGB (RR=0.92, p-value<0.0001) and LAGB (RR= 0.84, p-value=0.0001). Adolescents undergoing bariatric surgery had fewer comorbidities (55.4% vs 81.1%, p-value<0.0001), experienced fewer complications (3.3% vs 4.9%, p-value<0.0001) and 30-day readmissions (3.8% vs 5.0%, p-value=0.0029). Length of stay was also found to be significantly shorter for the adolescent population (1.73 vs 2.00 days, p-value<0.0001). After adjusting for other confounding factors, adolescent patients still had significantly lower complication risk (p-value=0.01) and shorter length of stay (p-value=0.0005) than adults. ConclusionBariatric surgery procedure rates have increased in the adolescent population with increasing trend of using LSG. The data from our study supports that bariatric surgery is safe in adolescents with significantly lower complication risk and shorter length of stay as compared to the adult population.

Preoperative exercise as a predictor of weight loss in adolescents and young adults following sleeve gastrectomy: a cohort study

BackgroundPreoperative exercise is associated with weight loss following bariatric surgery in adults, but this relationship in adolescents and young adults (AYA) is not well studied. ObjectivesThe present study examined AYA-reported preoperative exercise and demographic factors and their prediction of percent excess body mass index (BMI) loss at 6 and 12 months following sleeve gastrectomy. SettingThe setting for recruitment and surgeries was in a children’s hospital in the United States. MethodsParticipants were 173 AYA aged 12–21 years (mean age, 16.5 [SD, 2.0] yr; mean preoperative BMI, 50 [SD, 8.5] kg/m2). Demographic characteristics including age, sex, ethnicity, and preoperative BMI were extracted from the medical record. Preoperatively, adolescents self-reported on exercise using 5 items from the Center for Disease Control’s Youth Risk Behavior Surveillance Survey. The study evaluated the association of self-reported preoperative exercise in total and obtained a threshold of higher exercise to weight loss at 6 and 12 months after surgery. ResultsMore preoperative exercise was associated with greater weight loss at 12 months. Grouping participants by those who reported exercising at high levels (≥5 hr/wk) compared with those who reported <5 hr/wk, high levels of exercise predicted greater weight loss at 6 and marginally at 12 months postoperatively. Lower preoperative BMI was a significant predictor of weight loss in all analyses. ConclusionsPreoperative exercise may predict and contribute to weight loss in AYA and could be a target for pre- and postoperative intervention to improve outcomes. The importance of lower preoperative BMI for maximizing postoperative weight loss was also supported.

Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity.

Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity. The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design. Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight. All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%). Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.

Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24months.

Growing evidence supports the efficacy of paediatric bariatric surgery. However, there is a paucity of data examining adolescent outcomes post surgery. Among adults, studies have shown that early weight loss is associated with long-term weight loss. Therefore, the aim of our study was to investigate the association between early weight loss at 3months with longer-term weight loss at 12 and 24months in adolescents post surgery. We hypothesized that patients who have greater weight loss within the first 3months will have greater weight loss at 12 and 24months post surgery. A retrospective chart review of bariatric surgery patients (n=28) was conducted. Anthropometric measurements at baseline and 3, 12, and 24months were analysed. Percent of excess weight loss (%EWL) at 3, 12, and 24months were 33.6±11.3%, 55.0±20.5%, and 55.1±27.1%, respectively. %EWL at 3months was positively associated with %EWL at 12 and 24months (P<0.05). Receiver operating characteristic curve results identified a cut-off of greater than or equal to 30%EWL at 3months predicted successful weight loss, defined as greater than or equal to 50%EWL at 12 and 24months. These findings demonstrate that majority of weight loss among adolescents occurs within the first postoperative year. Greater %EWL by 3months post surgery predicts successful and sustained weight loss over time.

Abstract P327: Increased Physical Activity in Adolescents Post-Weight Loss Surgery is Associated with Improvements in CVD-Related Lipid Measures

Introduction: Severe obesity is increasing in adolescents and is strongly associated with CVD risk. Weight loss surgery (WLS) effectively treats severe obesity and improves CVD-related lipid measures. Independent of weight loss (WL), physical activity (PA) also improves lipid-related CVD measures and is key to WL maintenance. Longitudinal PA behaviors post-WLS and the impact on CVD-related lipid measures in adolescents is unclear, in part because PA data are largely self-reported. Hypothesis: We assessed the hypothesis that PA improves plasma lipids beyond that associated with active WL in adolescents, post-WLS. Methods: We used objective StepWatch TM PA data from 108 participants of the Teen-LABS bariatric surgery study from baseline to 3 years post-WLS. Inclusion criteria included 1) at least 3 days (1 weekend day and 2 weekdays) of recorded StepWatch TM data, including 6 hours or more of continuously recorded data per day, 2) at least 10 steps per hour, 3) data at baseline and one or more postoperative time points (6 months, 1 year, 2 years and/or 3 years), and 4) matched laboratory and anthropometric data. Participants on lipid lowering therapy were excluded. The primary outcome of interest was absolute change in plasma lipids (TC, TG, HDL-C, LDL-C, and non-HDL-C), holding sex, race, time, % change in iliac waist circumference and procedure constant in a linear regression model with generalized estimating equations assuming an exchangeable working correlation structure. PROC TRAJ in SAS was used to determine the optimal number of group activity trajectories based on step counts at all visits. Results: Two activity groups were identified from PROC TRAJ : less and more active. When considering all mean daily step count data, the overall mean was 4241 (95% CI: 3970, 4513), the more active trajectory mean was 8494 (95% CI: 7596, 9392), and the less active trajectory mean was 3722 (95% CI: 3530, 3915), all well below the recommended 12,000 steps for age. Yet statistically and clinically significant differences by activity trajectory emerged. Greater absolute decreases in LDL-C and non-HDL-C (-15 mg/dL [95% CI: (-28, -2)], p =0.026 and -15 mg/ld. [95% CI: (-28, -1)], p = 0.035), respectively, were associated with activity, holding stated co-variables constant. Activity was also associated with greater percentages of TG, LDL-C and non-HDL-C values being within acceptable ranges, by 2011 NIHLB Integrated Criteria, at 2 years, (TG, 83% vs 70%; LDL-C, 100% vs 83%; non-HDL-C, 83% vs 70%). Conclusion: In conclusion, greater improvement in CVD-related lipid measures was associated with more activity 2 years post-WLS in adolescents, one year post-active WL. Of great interest, the predominant lipid measure influencing CVD risk post-WLS was not HDL-C, as reported in adults. Importantly, the PA-associated reductions of LDL-C, and non-HDL-C are more strongly associated with improved CVD risk than HDL-C increase.

Change in gastrointestinal symptoms over the first 5 years after bariatric surgery in a multicenter cohort of adolescents

BackgroundRoux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are effective for weight loss in adolescents with severe obesity. However, little is known about adverse gastrointestinal symptoms (GIS) following these operations in adolescents. The objective was to examine GIS over 5 years after surgery and differences by surgery type. MethodsWe prospectively studied 228 adolescents (161 RYGB, 67 VSG) undergoing bariatric surgery. Gastrointestinal symptoms were assessed before surgery, at 6-months, and yearly to 5 years after surgery. Symptom severity was dichotomized for analysis. Analysis of post-surgery symptoms involved linear models adjusting for baseline symptoms, BMI, early post-operative complication, sex, and race. ResultsParticipants at surgery were 17 ± 1.6 years with preoperative BMI 53 ± 9.4 kg/m2. From 6 months to 5 years, gastroesophageal reflux symptoms (GERS), nausea, bloating, and diarrhea increased. Crude prevalence rates of GERS increased from 4% (1% RYGB, 11% VSG) at 6-months post-surgery to 14% (10% RYGB, 26% VSG) at 5-years. In adjusted analyses, the VSG group experienced 4-fold (4.85 95% CI 2.63, 8.91, p < 0.0001) greater odds of GERS compared to RYGB. ConclusionsAdolescents who underwent VSG experienced greater risk of GERS compared to those undergoing RYGB. Adolescents undergoing VSG should be counseled preoperatively about GERS and objectively monitored postoperatively for gastroesophageal reflux when indicated. Clinical trial registrationClinicalTrials.gov, Identifier: NCT00474318, https://clinicaltrials.gov/ct2/show/NCT00474318?term=Teen-LABS&rank=1. Type of StudyTreatment Study. Level of EvidenceLevel II.

Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy.

Introduction: Resting energy expenditure (REE) is often evaluated in adults and adolescents with obesity to estimate caloric requirements when advising dietary changes. However, data are lacking regarding the accuracy of methods used to clinically assess REE in adolescents with severe obesity. Moreover, there are no data regarding the effects of sleeve gastrectomy (SG) on REE in adolescents. We evaluated the accuracy and error rate between estimated and measured REE in adolescents with severe obesity and changes in REE following (SG).Materials and Methods: Cross-sectional study (CSS): 64 adolescents and young adults, 14–22 years old, with moderate to severe obesity were enrolled. We measured REE (mREE) by indirect calorimetry and estimated REE (eREE) using Derumeaux (Deru), Mifflin-St Jeor (MS), Harris Benedict (HB), and World Health Organization (WHO) equations. DXA was used to determine body composition. Bland Altman analysis evaluated agreement between eREE and mREE. Longitudinal study: 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition.Results: CSS: Median BMI was 45.2 kg/m2 and median age was 18.0 (16.3–19.9) years. mREE correlated strongly with eREE . Bland Altman analysis demonstrated that only a few points were beyond the 1.96 SD limit of disagreement. However, there was considerable overestimation of mREE by most equations. Longitudinal Study: In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7–2234) to 1580.5 (1326–1862.5) Calories (p = 0.002); however, the ratio of REE/Total Body Weight (TBW) increased from 13.5 ± 2.3 at baseline to 15.5 ± 2.2 at 1 year (p = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months (R = 0.625; p = 0.03) and negatively with % fat mass at 12 months (R = −0.669; p = 0.024).Discussion: In adolescents with moderate-severe obesity, despite a correlation between mREE using indirect calorimetry and eREE using the Deru, MS, HB, and WHO equations, there is significant over-estimation of REE at the individual level, challenging their clinical utility. One year after SG, REE/TBW increased and strongly correlated with % total weight loss in adolescents.

Efficacy of very low-energy diet programs for weight loss: A systematic review with meta-analysis of intervention studies in children and adolescents with obesity.

The objective of this review was to evaluate the efficacy and safety of very low-energy diet (VLED) programs for weight loss in children and adolescents with obesity. Six electronic databases were searched identifying 24 eligible studies (16 pre-post studies, four nonrandomized trials, two randomized controlled trials [RCTs], and two chart reviews) published up to October 2018. Studies were in English, implemented a VLED (≤3360kJF/day [≤800kcal/day] or <50% estimated energy requirements) in 5- to 18-year-olds with obesity, and reported at least one weight-related outcome. Weight-related outcomes significantly improved postintervention in all studies. Meta-analysis of 20 studies indicated a mean 10.1kg (95% confidence interval [CI], 8.7-11.4kg, P<0.001; I2 =92.3%) weight loss following interventions lasting 3 to 20weeks. Moderator analysis indicated greater weight loss in adolescent-only studies (10-18years) and formulated meal replacement interventions and inpatient settings. Meta-analysis of seven studies reporting weight at follow-up (5-14.5months from baseline) indicated 5.3 kg mean weight loss (CI, 2.5-8.0kg, P<0.001; I2 =50.6%). Details of adverse events were limited. VLED programs are effective for treating children and adolescents with obesity. However, conclusions on their safety cannot be drawn from the existing literature at this time. Future studies should include long-term follow-up with ongoing support and comprehensive monitoring of all adverse events.

Exercise Dose and Weight Loss in Adolescents with Overweight-Obesity: A Meta-Regression.

A recent meta-analysis reported that exercise interventions are effective for promoting weight loss in adolescents with overweight-obesity. However, the meta-analysis did not investigate whether there is an optimal exercise dose for promoting weight loss in overweight and obese adolescents. A common method of expressing exercise dose is the calculation of metabolic equivalents (METs), expressed as MET-h/week. The objective of this study was to determine the association between exercise dose (MET-h/week) and weight loss [body weight, body mass index (BMI)] in adolescents with overweight-obesity. Trials included in the original meta-analysis were extracted, and a subsequent search to identify studies published between May 2015 and May 2018 was conducted. The search included electronic databases (PubMed, Web of Science SPORTDiscus, Google Scholar) and the reference lists of eligible articles and relevant reviews. The inclusion criteria were as follows: (i) randomized controlled trial; (ii) structured exercise intervention, alone or combined with other intervention components; (iii) control group received no structured exercise or behavioral modification designed to increase physical activity; (iv) participants overweight or obese (BMI ≥ 85th percentile); and (v) participants aged between 10 and 19years. Fifteen trials were extracted from the original meta-analysis. The current search identified an additional five trials (three articles). Data from 20 trials (16 articles) involving 1091 participants (54% female, 17% not reported) were included in the analysis. Effect sizes were reported as mean difference, and random effects meta-regression quantified the association between exercise dose and weight loss. Study quality was assessed using a modified Jadad's scale. Total body weight change (decrease) ranged from - 2.7 to 19.3 (median 2.5)kg, and BMI change (decrease) ranged from - 1.6 to 6.3 (median 0.9)kg/m2. MET-h/week ranged from 5.4 to 36.0 (median 6.0). Each MET-h/week was associated with a 0.13kg/m2 (95% confidence interval [CI] 0.08-0.19) and 0.33kg (95% CI 0.08-0.59) decrease in BMI and body weight, respectively. The prescribed exercise dose for the majority of trials was low. As such, we were unable to discern whether there was an optimal exercise dose for weight loss (i.e., if the association between dose and weight loss was non-linear). Additionally, most trials had small sample sizes (median n=34) and 17 trials had methodological limitations. Each MET-h/week was associated with a 0.13kg/m2 and 0.33kg decrease in BMI and body weight, respectively. While this relationship appears to be linear, i.e., no optimal exercise dose, it should be emphasized that the exercise prescription dose for the majority of trials was low. Subsequent trials, with greater exercise dosage, are required to determine whether there is an 'optimal' dose for promoting weight loss in adolescents with overweight-obesity. However, the current findings lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in this population.

Motivations for weight loss in adolescents with overweight and obesity: a systematic review

BackgroundAdolescents with overweight and obesity report various motivations for weight loss other than the desire for better health. However, there is little evidence regarding the main motivations for weight loss in adolescents. The present systematic review aimed to identify the motivations for weight loss in adolescents with overweight and obesity.MethodsA systematic search for original articles published up to December 2016 was carried out in the PubMed, Scopus, LILACS, and ADOLEC databases. The terms used in the search were: motivation, motive, reason, “weight loss,” “lose weight,” and adolescent.ResultsSix studies (all cross-sectional) met the selection criteria and were included in the review. The instruments used to assess the participants’ motivations for weight loss were interviews and questionnaires with open questions. Seventeen motivations for weight loss were identified, the main ones being better health, esthetic/cosmetic reasons, improvements in self-esteem, and avoidance of provocation/bullying.ConclusionsThe results of the present review show the need for validated instruments to assess the motivations for weight loss in adolescents with overweight and obesity. Moreover, the high frequency of motivations for weight loss related to appearance and social acceptance evidences the need for multidisciplinary weight loss interventions that consider not only the biological factors, but also the psychological and social aspects.

Surveying the Literature

Surveying the Literature

A121 - Sleeve Gastrectomy in 2,019 Children and Adolescents: Nine Years Long-Term Outcomes

Background: Bariatric surgery has proven safety and efficacy in inducing significant weight loss and co-morbidity resolution in children and adolescents. However, long-term evidence in this age group is yet to be reported.