ESPE Abstracts

Introduction: Until recently, bariatric surgery (BS) has been the only option for clinically meaningful weight reduction for adolescents and youth with extreme obesity. Low participation rate in follow-up examinations and low supplement intake after BS in adolescents has been described in literature (PMID: 24048144, 25078533). We developed a structured pre- and post-bariatric surgery program in order to improve follow-up rate and supplement intake in adolescents and youth after BS. The aim of the structured preparation program was also to enable patients with interest in BS to make an active decision for BS or to rethink interest in BS.

Methods: The Youth with Extreme Obesity Study (YES) is a multicenter cohort study, including adolescents and young adults (14–24 years) with obesity (BMI≥30.0 kg/m²). The effect of weight loss surgery (sleeve gastrectomy) within a structured pre- and 12-month post-surgery program (clinicaltrials.gov NCT02062164) was studied (subproject of YES). A multidisciplinary team provided training on medical aspects of BS and on nutrition and physical activity after BS.

Results: After participation in the structured pre-surgery program, 17/26 (f:67%) decided to undergo BS. Nine patients did not undergo surgery. Reasons were: patients lost weight in pre-surgery preparation due to participation in an inpatient program that favors lifestyle modification and decided against surgery, active decision against surgery since they felt too young for such a life threating operation, patients changed their mind several times. Follow-up rate 12 months (T1) after BS was high (94%). All patients achieved a significant weight reduction with a relevant weight loss (ΔBMI: -16.1±5.6 kg/m²). Six patients achieved BMI values ≤35kg/m² at T1. 71% of the patients reported that they took the prescribed dietary supplements in the first year after BS, 42% of them daily. 11/17 patients achieved BMI values that fall within the range of parental BMI values. In contrast to the high follow-up rates at T1, majority of the patients stopped active presentation at the specialized centers in the long-term course (24-month FUp:43%, 36-month FUp:27%).

Conclusion: The participation in a structured pre bariatric surgery program resulted for some patients in a change of their previously made decision. Adolescents and youth with extreme obesity with BS may benefit from a structured pre- and post-treatment program in a specialized obesity center in the first year after surgery. We also realize that new long-term treatment concepts after BS in adolescents and youth are necessary in order to assure long-term safety and efficiency.