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Adolescent surgery

AMOS study reports benefits of surgery for adolescents

Surgery was generally well tolerated and the quality of life increased significantly
Torsten Olbers

Bypass surgery can benefit adolescents with severe obesity just as much as adults, according to the two year results from the Swedish Nationwide Study (AMOS).

Published in the  International Journal of Obesity, the study reported that 81 teenagers lost an average of 96.8lbs (43.9kg) following surgery, significantly improving their health and quality of life.

"The results are surprisingly good,” said Torsten Olbers, a researcher at Sahlgrenska Academy, Senior Surgeon at Sahlgrenska University Hospital, Sweden and the leader of the study. “We will certainly want to carefully examine potential adverse effects of gastric bypass surgery in teenagers.”

The study involved 81 adolescents (13–18 years) with BMI ranging from 36–69 undergoing laparoscopic gastric bypass surgery between April 2006 and May 2009. For weight change comparisons, the researchers identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care. The primary outcomes measures were two-year BMI in both groups, and metabolic risk factors and quality of life in the adolescent surgery group.

Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5±6.1 at baseline and 30.2 (confidence interval 29.1–31.3) (p<0.001), corresponding to a 32% weight loss and a 76% loss of excess BMI.

The two-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20mU l−1) was present in 70% of the adolescent surgery patients, which was reduced to 0% at one year and 3% at two years. Other cardiovascular risk factors were also improved.

Two-thirds of adolescents undergoing surgery had a history of psychopathology. The researchers said that the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients.

"The teenagers who participated in the study represent a highly vulnerable group, with a history of psychosocial problems related to obesity, including bullying and underlying mental disease," said Olbers. “We know from earlier studies that teenagers with severe obesity are at risk of developing other diseases and poorer quality of life as adults. For that reason, we hope that the method can eventually be offered to more teenagers.”

The researchers stress that gastric bypass surgery does not automatically have an effect on psychological problems: some of the teenagers continued to experience them despite having lost weight.

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