Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery.

BACKGROUND/OBJECTIVES: Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient-reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a nonsurgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes. SUBJECTS/METHODS: Multi-site data from 139 adolescents undergoing bariatric surgery (Mage = 16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI] = 51.5 kg/m2) and 83 comparators (Mage = 16.1; 81.9 % female, 54.2% White; MBMI = 46.9 kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes. RESULTS: Significant improvement in WRQOL and Physical HRQOL, particularly in the first postoperative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had significantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were significantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating. CONCLUSIONS: For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early postoperatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Family factors that characterize adolescents with severe obesity and their role in weight loss surgery outcomes.

OBJECTIVE: To comprehensively assess family characteristics of adolescents with severe obesity and whether family factors impact weight loss outcomes following weight loss surgery (WLS). METHODS: Multisite prospective data from 138 adolescents undergoing WLS and primary caregivers (adolescent: Mage = 16.9; MBMI = 51.5 kg/m2 ; caregiver: Mage = 44.5; 93% female) and 83 nonsurgical comparators (NSComp: adolescent: Mage = 16.1; MBMI = 46.9 kg/m2 ; caregiver: Mage = 43.9; 94% female) were collected using standardized measures at presurgery/baseline and at 1 and 2 years. RESULTS: The majority (77.3%) of caregivers had obesity, with rates of caregiver WLS significantly higher in the WLS (23.8%) versus NSComp group (3.7%, P < 0.001). Family dysfunction was prevalent (≈1 in every two to three families), with rates higher for NSComp than the WLS group. For the WLS group, preoperative family factors (i.e., caregiver BMI or WLS history, dysfunction, social support) were not significant predictors of adolescent weight loss at 1 and 2 years postoperatively, although change in family functioning over time emerged as a significant correlate of percent weight loss. CONCLUSIONS: Rates of severe obesity in caregivers as well as family dysfunction were clinically noteworthy, although not related to adolescent weight loss success following WLS. However, change in family communication and emotional climate over time emerged as potential targets to optimize weight loss outcomes.

A Community-based Healthy Living Promotion Program Improved Self-esteem Among Minority Children.

OBJECTIVES: Improving self-esteem, dietary habits, and physical activity is essential for long-term success in childhood obesity prevention. The aim is to evaluate the effects of a healthy living promotion program, Healthy Kids-Houston, on BMI, dietary habits, self-esteem, and physical activity among minority children. METHODS: The after-school program was implemented at community centers in low-income neighborhoods with close proximity to public schools. The program consisted of 3 6-week sessions. Each week, children attended 2 2-hour sessions. Each 2-hour session in the intervention included 90 minutes of structured physical activities and 30 minutes of nutrition and healthy habit lessons. The control group received typical enrichment programs. Outcomes were measured before the intervention and at the end of each 6-week session. RESULTS: We enrolled 877 children (age 10.2 ±â€Š0.1 years (mean ±â€ŠSE); body mass index z score: 1.49 ±â€Š0.1; 52.0% boys; 72.6% Hispanic) in the program with 524 children received the intervention at 14 community centers and 353 children served as control at 10 community centers. The intervention led to no improvements in BMI z score (P = 0.78) and dietary habits (P = 0.46). Significant improvements (P ≤ 0.02) were detected in the amount of exercise that a child perceived to be required to offset a large meal and in several key self-esteem scores. No improvements were detected in physical activities (P ≥ 0.21). CONCLUSIONS: The improvement in some key self-esteem scores and nutrition knowledge may act as a mediator to motivate these children to adopt a healthier lifestyle in the future.

A multisite view of psychosocial risks in patients presenting for bariatric surgery.

OBJECTIVE: The psychosocial health of adolescents with severe obesity (BMI ≥ 120% for age and gender) has only recently been the focus of empirical work. METHODS: This multisite study-an ancillary to a prospective longitudinal observational study documenting health in adolescents having weight loss surgery (WLS)-presents preoperative/baseline data from 141 WLS adolescents and 83 nonsurgical comparisons (NSComps). Self-report data from adolescent and caregiver dyads characterize adolescent psychopathology and potential correlates. RESULTS: One in three adolescents reported internalizing symptoms, and one in five endorsed externalizing symptoms in the clinical range. Generalized linear model analysis demonstrated that increased risk of psychopathology for adolescents with severe obesity was associated with family dysfunction, eating pathology, family composition, and seeking behavioral intervention (versus WLS), whereas better quality of life (QOL) was associated with lower psychopathology. CONCLUSIONS: While psychopathology rates are comparable to national samples, there is a subgroup of youth who present for behavioral weight loss services and are at greater risk for psychopathology relative to national adolescent base rates. Adolescents who achieve candidacy for WLS may be a highly selective population of youth with severe obesity and may have lower base rates of psychopathology compared to NSComps.

Body weight has no impact on self-esteem of minority children living in inner city, low-income neighborhoods: a cross-sectional study.

BACKGROUND: The relationship between body weight and self-esteem among underserved minority children is not well documented. METHODS: We measured the self-esteem profile using the Self-Perception Profile for Children among 910 minority children at 17 Houston community centers. RESULTS: Weight status had no effect on any of the self-esteem scores among the minority children (P ≥ 0.21). Black children had higher scholastic competence than Hispanic children (P = 0.05). Social acceptance was not affected by age, gender, and race/ethnicity (P ≥ 0.13). Significant age x gender (P = 0.006) and race x gender (P = 0.005) interactions were detected on athletic competence. The younger boys had higher athletic competence than the younger and older girls (P ≤ 0.01). The older boys had higher athletic competence than the older girls (P = 0.008) but their scores were not different from those of the younger girls (P = 0.07). Within each race/ethnicity group, boys had higher athletic competence than girls (P ≤ 0.03). Black boys had higher athletic competence than Hispanic girls (P = 0.007) but their scores were not different from those of the Hispanic boys (P = 0.08). Age and gender had no effect on physical appearance but black children had higher scores than Hispanic children (P = 0.05). Behavioral conduct was not affected by age, gender, or race/ethnicity (P ≥ 0.11). There was an age x gender interaction on global self-worth (P = 0.02) with boys having similar scores regardless of ages (P = 0.40) or ethnicity (P = 0.98). However, boys from both age groups had higher global self-worth than the older girls (P ≤ 0.04) but their scores were not different from those of the younger girls (P ≥ 0.07). CONCLUSIONS: For the first time, we documented that being normal weight did not necessarily guarantee positive self-esteem among minority children. Their self-esteem scores were similar to those found among children who were diagnosed with obesity and obesity-related co-morbidities and lower than those reported among normal-weight white children. Therefore, activities to promote self-esteem are important when working with underserved minority children in order to promote a healthy lifestyle.

A residential summer camp can reduce body fat and improve health-related quality of life in obese children.

In an earlier report, we showed that a 2-week, residential summer camp (Kamp K'aana) led to improved body weight, body mass index, body mass index z score, and self-esteem among obese children. To assess whether improvements in body weight and self-esteem translate into improvement in body fat and weight-related quality of life, we measured the changes in body fat by bioimpedance and quality of life by Impact of Weight on Quality of Life instrument on 42 multiethnic obese children who took part in our Kamp K'aana program. Significant reduction in body fat was detected with significant improvements in the weight-related quality of life scores.

Multicomponent school-initiated obesity intervention in a high-risk, Hispanic elementary school.

The aim of the study was to determine the effectiveness of a school-initiated cognitive and behavioral program to reduce childhood obesity. Height, weight, body mass index (BMI), and BMI z scores were obtained at the beginning and end of the school year at an intervention school (n = 1022) and at a control school (n = 692). The prevalence of overweight and obesity was 18.9% and 30.4% versus 19% and 30.2%, respectively, in the intervention and control schools. The incidence of overweight increased in the control school, but the incidence of obesity, weight, and BMI z scores increased significantly in the intervention school, suggesting that implementation of any school-based obesity intervention programs requires careful planning to achieve goals.

An innovative summer camp program improves weight and self-esteem in obese children.

To determine the potential benefits of a residential summer camp to treat childhood obesity, 21 obese, multiethnic children (aged 11.4+/-1.4 years; body mass index [BMI] percentile 98.5+/-1.4; BMI z score 2.30+/-0.33) from a diverse socioeconomic background were enrolled in a 2-week summer camp program. Significant improvements (P<0.04) were observed in self-esteem (+0.27+/-0.33 point), body weight (-3.7+/-1.2 kg), BMI (-1.60+/-0.48 kg/m), BMI z score (-0.12+/-0.06), number of curl ups (+10.9+/-21.5), systolic and diastolic blood pressure (-10.8+/-13.4 and -9.4+/-5.5 mmHg, respectively), and heart rate (-8.2+/-12.7 bpm).

Psychological predictors of success in a pediatric cognitive-behavioral weight-control program.

Carmen Mikhail, PhD, and her coauthors explore the relationship between psychological profiles and success in a pediatric cognitive-behavioral weight-control program.