Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review.

The selection criteria, safety, and efficacy of bariatric surgery are well established in adults but are less well defined for severely obese adolescents. The number of severely obese adolescents who could benefit from weight loss surgery is increasing, although referral rates have plateaued. Surgical options for these adolescents are controversial and raise several questions. Recent studies, including the prospective Teen-Longitudinal Assessment of Bariatric Surgery Study and the Adolescent Morbid Obesity Surgery Study, help answer these questions. Early bariatric surgical intervention improves body mass index but, more importantly, improves cardiovascular and metabolic co-morbidities of severe obesity. A review of the medical, psychosocial, and economic risks and benefits of bariatric surgery in severely obese adolescents is a step toward improving the management of a challenging and increasing population. We describe the current knowledge of eligibility criteria, preoperative evaluation, surgical options, outcomes, and referral barriers of adolescents for bariatric surgery.

A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults.

INTRODUCTION: Mounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern. Additionally, young adults and racial/ethnic minorities are both increasingly undergoing WLS and are at heightened risk for problems related to alcohol use. To date, these groups have been under-represented in study samples. METHODS: To address these important gaps in the literature, racially/ethnically diverse, young adult WLS patients who indicated a post-WLS increase in alcohol use (n = 12) participated in an individual, semi-structured qualitative interview. Data were analyzed through two coding cycles; an external audit of the emerging themes was also conducted to further ensure the trustworthiness of the data. RESULTS: Interviews revealed four major themes prompting an increase in alcohol use after WLS: (1) increased sensitivity to alcohol intoxication, (2) utilizing alcohol as a replacement self-soothing mechanism for food, (3) increase in socialization, and (4) utilizing alcohol as a coping mechanism. CONCLUSIONS: By understanding the drivers of increases in alcohol use after WLS, precision-targeted pre- and post-surgical counseling interventions can be developed to address this emerging concern.

Predictors of short-term diabetes remission after laparoscopic Roux-en-Y gastric bypass.

PURPOSE: A remission of type 2 diabetes mellitus (T2DM) is one of the major goals of the contemporary bariatric surgery. The goal of our study is to identify predictors of short-term postoperative diabetes remission in order to facilitate preoperative patient selection. MATERIALS AND METHODS: Two hundred forty-five obese (body mass index (BMI) ≥35 kg/m2) T2DM subjects who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) were followed up to 1 year after bariatric surgery. Diabetes remission was defined as hemoglobin A1c (HbA1c) ≤6 % and fasting blood glucose (FBG) <100 mg/dl in absence of all diabetic medications. RESULTS: Twenty-six percent of the patients seen in f/u achieved complete remission at 1 year. Average Hba1c decreased from 8 to 6.7% and 6.4% after 6 and 12 months, respectively. Regression analysis showed that age (p = 0.01), number of diabetes complications (p = 0.03), family history of diabetes (p = 0.04), preoperative use of insulin (p = 0.04), and peri- and postoperative weight loss (p = 0.05, for both) were the best preoperative predictors of diabetes remission at 6 and 12 months (R(2) = 0.3). CONCLUSION: Younger patients, with fewer diabetic complications, no family history of diabetes, not using insulin, and with greater peri- and postoperative weight loss were the best candidates to achieve a rapid diabetes remission after RYGB.