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. 2018 Jan;42(1):102-107.
doi: 10.1038/ijo.2017.193. Epub 2017 Aug 14.

Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe obesity

J R Ryder  1 , A C Gross  1 , C K Fox  1 , A M Kaizer  1 , K D Rudser  1 , T M Jenkins  2 , M B Ratcliff  2 , A S Kelly  1 , S Kirk  2 , R M Siegel  2 , T H Inge  3
Affiliations

Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe obesity

J R Ryder et al. Int J Obes (Lond). 2018 Jan.

Abstract

Background/objectives: Bariatric surgery produces robust weight loss, however, factors associated with long-term weight-loss maintenance among adolescents undergoing Roux-en-Y gastric bypass surgery are unknown.

Subjects/methods: Fifty adolescents (mean±s.d. age and body mass index (BMI)=17.1±1.7 years and 59±11 kg m-2) underwent Roux-en-Y gastric bypass surgery, had follow-up visits at 1 year and at a visit between 5 and 12 years following surgery (Follow-up of Adolescent Bariatric Surgery at 5 Plus years (FABS-5+) visit; mean±s.d. 8.1±1.6 years). A non-surgical comparison group (n=30; mean±s.d. age and BMI=15.3±1.7 years and BMI=52±8 kg m-2) was recruited to compare weight trajectories over time. Questionnaires (health-related and eating behaviors, health responsibility, impact of weight on quality of life (QOL), international physical activity questionnaire and dietary habits via surgery guidelines) were administered at the FABS-5+ visit. Post hoc, participants were split into two groups: long-term weight-loss maintainers (n=23; baseline BMI=58.2 kg m-2; 1-year BMI=35.8 kg m-2; FABS-5+ BMI=34.9 kg m-2) and re-gainers (n=27; baseline BMI=59.8 kg m-2; 1-year BMI=36.8 kg m-2; FABS-5+ BMI=48.0 kg m-2) to compare factors which might contribute to differences. Data were analyzed using generalized estimating equations adjusted for age, sex, baseline BMI, baseline diabetes status and length of follow-up.

Results: The BMI of the surgical group declined from baseline to 1 year (-38.5±6.9%), which, despite some regain, was largely maintained until FABS-5+ (-29.6±13.9% change). The BMI of the comparison group increased from baseline to the FABS-5+ visit (+10.3±20.6%). When the surgical group was split into maintainers and re-gainers, no differences in weight-related and eating behaviors, health responsibility, physical activity/inactivity, or dietary habits were observed between groups. However, at FABS-5+, maintainers had greater overall QOL scores than re-gainers (87.5±10.5 vs 65.4±20.2, P<0.001) and in each QOL sub-domain (P<0.01 all).

Conclusions: Long-term weight outcomes for those who underwent weight-loss surgery were superior to those who did not undergo surgical treatment. While no behavioral factors were identified as predictors of success in long-term weight-loss maintenance, greater QOL was strongly associated with maintenance of weight loss among adolescents who underwent Roux-en-Y gastric bypass surgery surgery.

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Conflict of interest statement

Conflict of interest: Dr. Inge received research grant funding from Ethicon Endosurgery for this project. Dr. Kelly serves as a consultant for Novo Nordisk, Orexigen, and Vivus Pharmaceuticals but does not accept personal or professional income for these activities. Dr. Kelly receives research support in the form of drug/placebo from Astra Zeneca Pharmaceuticals. Dr. Fox serves as a site principal investigator for a clinical trial sponsored by Novo Nordisk Pharmaceuticals. The other authors declare no conflicts of interest. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Figures

Figure 1
Figure 1
Percent change in BMI from baseline in the surgical treatment (overall, maintainers, and re-gainers) versus non-surgical comparison group. Adolescents were classified as maintainers if percent change in BMI from baseline to FABS-5+ visit was within 20% of the original change in BMI from baseline to the 1-year follow-up visit.
Figure 2
Figure 2
Distribution of participants among obesity categories at FABS-5+ visit between groups.
See this image and copyright information in PMC

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