1
|
Beck RH, Afrooz I, Suhail Masalawala M, Watad R, Al Shaban T, Deeb A. Characteristics of adolescents referred for bariatric surgery in Abu Dhabi, United Arab Emirates. Front Pediatr 2024; 12:1297251. [PMID: 38523841 PMCID: PMC10957758 DOI: 10.3389/fped.2024.1297251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
About a third of children and adolescents are overweight or obese in the United Arab Emirates, and referrals for metabolic and bariatric surgery (MBS) are now common. Despite excellent evidence that MBS should be considered in adolescents with severe obesity, it remains a management approach of last resort in many cases. Baseline, real-world data on adolescent patients living with obesity referred for surgery, their characteristics, and how these relate to current and future referral policy are important to ensure best practice. Here we examined the demographic, anthropometric, and clinical characteristics of adolescents referred for MBS over a three-year period to Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Ninety-two adolescents living with obesity were recruited: 54.3% were female, the average age was 16.3 ± 2.4 years, and 88.0% of patients had a first-degree relative with a history of obesity and 62% a family history of bariatric surgery. The average BMI was 47.7 ± 10.5, and the average percentage of the 95th percentile BMI was 169.5 ± 38.8%. Complications of obesity (hypertension, type 2 diabetes and prediabetes, dyslipidemia, and liver function abnormalities) were common. Our analysis highlights that there exists a mismatch between the profiles of patients referred for MBS, local guidelines, and international best practice in decision-making for referral to MBS services. While many adolescents in the UAE seem to enjoy family support and experience in the surgical management of obesity, local guidelines need updating to reflect changes in the definitions of obesity, thresholds for referral, and to remove unnecessary developmental stage barriers to increase the window for personalized surgical management.
Collapse
Affiliation(s)
- Reem Hassan Beck
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Imrana Afrooz
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Rama Watad
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Talat Al Shaban
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
2
|
Lawton RI, Stanford FC. The Role of Racism in Childhood Obesity. Curr Obes Rep 2024; 13:98-106. [PMID: 38172479 PMCID: PMC10939728 DOI: 10.1007/s13679-023-00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Obesity rates continue to rise among children and have shown persistent racial disparities. Racism plays a potentially essential and actionable role in these disparities. This report reviews some mechanisms through which racism may shape childhood obesity. RECENT FINDINGS From the youngest ages, disparities in childhood obesity prevalence are already present. Racism may shape intergenerational and prenatal factors that affect obesity and various stressors and environments where children grow up. The relationships between clinicians and patients may also be shaped by everyday racism and legacies of past racism, which may affect obesity prevalence and treatment efficacy. Comprehensive data on the extent to which racism shapes childhood obesity is limited. However, compelling evidence suggests many ways through which racism ultimately does affect childhood obesity. Interventions to address racism at multiple points where it shapes childhood obesity, including intergenerational and prenatal mechanisms, may help to close disparities.
Collapse
Affiliation(s)
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA.
- MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, Weight Center, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA.
- Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Weight Center, 50 Staniford Street, 4th Floor, Boston, MA, USA.
| |
Collapse
|
3
|
Cheng V, Grinberg GG, Ashbrook M, Silva J, Samakar K, Yenumula PR. Predictors of Complications Following Bariatric Surgery for Adolescent Patients. Am Surg 2023; 89:4031-4037. [PMID: 37171881 DOI: 10.1177/00031348231175463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Bariatric surgery for adolescent patients has been shown to be safe but potentially underutilized. A better understanding of operative risk in adolescents may temper apprehension to its adoption. This study intends to examine the association between preoperative risk factors and complications following bariatric surgery for adolescent patients. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databank (2015-2020) was queried for all adolescent patients (10 to 19 years). Only patients who underwent sleeve gastrectomy or gastric bypass were included. Multivariable regression examined the association between patient characteristics and complications. RESULTS A total of 7785 adolescent patients satisfied inclusion criteria. The median age was 18 years, 1737 (22%) were male, and the median body mass index was 46. Of all patients, 6675 (86%) and 1310 (14%) underwent sleeve gastrectomy and gastric bypass, respectively. Preoperative chronic steroid use was significantly associated with higher rates of leak (odds ratio [OR] 7.327, P = .009), bleeding (OR 10.791, P = .003), and reoperation (OR 7.685, P < .001). While Pacific Islander race was also significantly associated with higher rates of reoperation (OR 11.773, P = .039), Asian race was significantly associated with higher rates of bleeding (OR 14.527, P = .042). A history of gastroesophageal reflux disease was associated with higher rates of postoperative reintervention (OR 2.306, P = .004). DISCUSSION Readily identifiable preoperative patient characteristics are significantly associated with higher rates of postoperative complications following adolescent bariatric surgery. Additional research is required to determine whether tailoring treatment based on these characteristics can improve outcomes.
Collapse
Affiliation(s)
- Vincent Cheng
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Gary G Grinberg
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Matthew Ashbrook
- Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jack Silva
- Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Panduranga R Yenumula
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| |
Collapse
|
4
|
McClelland PH, Kabata K, Gorecki W, Jano A, Zenilman ME, Gorecki P. Long-term weight loss after bariatric procedures for morbidly obese adolescents and youth: a single-institution analysis with up to 19-year follow-up. Surg Endosc 2023; 37:2224-2238. [PMID: 35879574 DOI: 10.1007/s00464-022-09434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity is a public health concern among adolescents and young adults. Bariatric surgery is the most effective treatment for morbid obesity and has been increasingly utilized in young patients. Long-term outcomes data for bariatric surgery in this age group are limited. METHODS This is a single-institution, prospective analysis of 167 patients aged 15-24 years who underwent one of three laparoscopic bariatric procedures between 2001 and 2019: Roux-en-Y gastric bypass (LRYGB, n = 71), adjustable gastric banding (LAGB, n = 22), and sleeve gastrectomy (LSG, n = 74). Longitudinal weight and body mass index (BMI) measurements were compared to evaluate patterns of weight loss. RESULTS All operations were completed laparoscopically using the same clinical pathways. Patients were predominantly female (82.6%), had a median age of 22.0 [Q1-Q3 20.0-23.0] years, and had a mean presurgical BMI of 48.5 ± 6.5 kg/m2 (range 38.4-68.1 kg/m2). All procedures produced significant weight loss by 1 year, peak weight loss by 2 years, and modest weight regain after 5 years. Mean percent weight/BMI losses at 5 years for LRYGB, LAGB, and LSG were - 36.7 ± 10.8%, - 14.5 ± 15.3%, and - 25.1 ± 13.4%, respectively (p < 0.001). LRYGB patients were most likely to achieve ≥ 25% weight loss at 1, 3, and 5 years and maintained significant average weight loss for more than 15 years after surgery. Reoperations were procedure-specific, with LAGB, LRYGB, and LSG having the highest, middle, and lowest reoperation rates, respectively (40.9% vs. 16.9% vs. 5.4%, p < 0.001). CONCLUSION All procedures provided significant and durable weight loss. LRYGB patients achieved the best and most sustained weight loss. LSG patients experienced second-best weight loss between 1 and 5 years, with lowest chance of reoperation. LAGB patients had the least weight loss and the highest reoperation rate. Compared to other factors, type of bariatric procedure was independently predictive of successful weight loss over time. More studies with long-term follow-up are needed.
Collapse
Affiliation(s)
- Paul H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Krystyna Kabata
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Wojciech Gorecki
- Department of Pediatric Surgery, Jagiellonian University Medical College, University Children's Hospital of Krakow, Krakow, Poland
| | - Antalya Jano
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Michael E Zenilman
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Piotr Gorecki
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| |
Collapse
|
5
|
Steinberger AE, Nickel KB, Keller M, Wallendorf M, Sprague J, Nicol GE, Dimou FM, Eagon JC, Eckhouse SR, Shakhsheer BA. National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017. Pediatrics 2022; 150:189942. [PMID: 36373280 DOI: 10.1542/peds.2022-057316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample. METHODS This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates. RESULTS From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P < .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P < .0001). The mean age was stable over time 18.10-17.96 (P = .78). The cohort was primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P < .001), whereas number of obesity-related comorbidities was stable (P > .05). Length of stay was <2 days (2.02-1.75, P = .04) and in-hospital complication rates were low (7.2% to 6.45%, P = .88). CONCLUSIONS Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.
Collapse
Affiliation(s)
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | - Matthew Keller
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | | | | | - Ginger E Nicol
- Child and Adolescent Psychiatry, Department of Psychiatry
| | | | | | | | - Baddr A Shakhsheer
- Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
| |
Collapse
|
6
|
Salimi-jazi F, Chkhikvadze T, Shi J, Pourmehdi-lahiji A, Moshksar A, Rafeeqi TA, Pratt J, Bruzoni M, Chao S. Trends in Adolescent Bariatric Procedures: a 15-Year Analysis of the National Inpatient Survey. Obes Surg. [DOI: 10.1007/s11695-022-06265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
|
7
|
Vuong L, Chang SH, Wan F, Wu N, Eagon JC, Eckhouse SR, Dimou FM. National Trends and Outcomes in Adolescents Undergoing Bariatric Surgery. J Am Coll Surg 2022; 235:186-94. [PMID: 35839393 DOI: 10.1097/XCS.0000000000000234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the US, obesity continues to be a severe health issue now affecting adolescents. Bariatric surgery remains the most effective treatment for obesity, but use among adolescents remains low. The objective of this study was to identify current national trends in bariatric surgery among adolescents. STUDY DESIGN Using the Nationwide Inpatient Sample database, adolescents aged 9 to 19 with a diagnosis of morbid obesity who underwent a laparoscopic gastric bypass (Roux-en-Y gastric bypass) or laparoscopic sleeve gastrectomy (SG) between 2015 and 2018 were identified. Demographics, comorbidities, and in-hospital complications were collected. National estimates were calculated. The trend of annual number of operations was determined by Kruskal-Wallis rank test. RESULTS Between 2015 and 2018, 1,203 adolescents were identified, resulting in a nationwide estimate of 4,807 bariatric cases. The number of bariatric operations increased annually from 1,360 in 2015 to 1,740 operations in 2018 (p = 0.0771). The majority of patients were female (76%), 17 to 19 years old (84.1%), and White (47.9%). Most patients underwent SG (82.0%). Black and Hispanic patients comprised 40.2% of the cohort. Significant comorbidities included diabetes, dyslipidemia, nonalcoholic fatty liver disease, hypertension, and sleep apnea. The average length of stay decreased from 2.12 days to 1.64 days. There were no in-hospital mortalities, and complications were less than 1%. CONCLUSIONS With the increasing prevalence of obesity among adolescents in the US, bariatric surgery increased over time but was performed less in patients younger than 16 years of age and racial minorities. Bariatric surgery among adolescents remains safe, with extremely low complication rates and zero in-hospital mortality.
Collapse
|