Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis
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Metabolic and bariatric surgery is an effective strategy to curb the natural history of obesity progression and improve psychosocial status in the short term for adolescents with severe obesity. The medium- and long-term psychosocial impact of bariatric surgery in this population is not established.
We searched MEDLINE (Ovid), EMBASE, Web of Science, PsycInfo, and the Cochrane Libraries through October 2017 for reports of weight loss surgery (roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding) on adolescents with severe obesity (age ≤ 21 years) having ≥ 6 months of follow-up. The primary outcome for inclusion in systematic review was use of a validated quality of life (QoL) or other psychosocial instrument at baseline and postoperatively. We used standardized mean difference (SMD) and random-effects modeling to provide summary estimates across different instruments.
We reviewed 5155 studies, of which 20 studies met inclusion criteria for qualitative synthesis. There were 14 studies and 9 unique cohorts encompassing 573 patients which were eligible for meta-analysis regarding postoperative change in QoL. Across surgical procedures, there was significant improvement in QoL of 1.40 SMD (95% confidence interval 0.95 to 1.86; I2 = 89%; p < 0.001) at last follow-up (range 9–94 months). Trends in QoL improvement demonstrated the greatest improvement at 12 months; however, significant improvement was sustained at longest follow-up of 60+ months.
Weight loss surgery is associated with sustained improvement in QoL for adolescents with severe obesity across surgical procedures. Long-term data for psychosocial outcomes reflecting other mental health domains is lacking.
KeywordsAdolescent Bariatric surgery Psychosocial outcomes Quality-of-life
We are thankful for and gratefully acknowledge the guidance of Marc P. Michalsky, MD, and Meg H. Zeller, PhD, in helping to define the criteria for our search strategy as well as with the interpretation and framing of our results.
This material is based upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
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