Effect of Demographic and Psychological Factors on 12 Month Outcomes in Adolescent Bariatric Surgery

Background: Weight loss surgery is an increasingly utilized treatment for adolescents with severe obesity. This study aims to investigate the effect of demographic variables (age, gender and ethnicity) and pre-surgical mental health on the change in BMI (% excess BMI loss) after Laparoscopic Sleeve Gastrectomy (LSG) in adolescents with obesity.Methods: Retrospective chart review of a prospective LSG patient database (N=196, 75% female, 75% minority) was performed. Change in BMI at 3, 6 and 12 months after surgery was assessed. Mental health diagnoses evaluated using a structured interview (KSADS) were obtained at the pre-surgical evaluation. A non-linear Latent Variable Growth Model (LGM) was estimated, including demographic variables and presence/absence of diagnoses in the classes of anxiety, depression, attentional disorders, and eating disorders.Results:The presence of a diagnosis of anxiety, depression, or ADHD was not associated with change in BMI at any time point. The presence of a diagnosed eating disorder was associated with less excess BMI loss at 3 months, but not thereafter. Change in BMI at 3 months was significantly associated with change in BMI at 12 months (r=0.892, P<0.001). 6 month outcomes (I=0.650) had a larger effect on 12 month outcomes than those at 3 months (I=0.516). Age, gender, and ethnicity were not associated with 12 month change in BMI.Conclusions: Our data indicate that there is no association of demographic variables or mental health diagnoses with 12 month change in BMI following LSG in adolescents. Thus neither age nor presence of a mental health diagnosis should be contraindications to LSG; but assessment and treatment of disordered eating should remain a key part of preparation for surgery. Also, the larger effect of the 6 month change in BMI on the 12 month outcome suggests there may be a window in which patients exhibiting suboptimal BMI change at 3 months can be identified and an intervention provided to optimize % excess BMI loss.