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+ ( -2 9.6±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.
Bibliographical noteFunding Information:
Dr Fox receives salary support for her role as a site principal investigator for Novo Nordisk Pharmaceuticals. The other authors have no financial relationships relevant to this article to disclose. Dr Rudser and Mr Kaizer are supported in part by the National Center for Advancing Translational Sciences/NIH (UL1TR000114). The other authors received no funding for this project.
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 remaining authors declare no conflicts of interest. No honorarium, grant or other form of payment was given to anyone to produce the manuscript.
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