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Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery

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Abstract

Background

Factors contributing to adolescents’ non-completion of bariatric surgery, defined as self-withdrawal during the preoperative phase of care, independent of program or insurance denial, are largely unknown. Recent adolescent and adult bariatric surgery literature indicate that psychological factors and treatment withdrawal play a role; however, for adolescents, additional age-salient (family/caregiver) variables might also influence progression to surgery.

Objectives

The present study examined demographic, psychological, and family/caregiver variables as predictors of whether adolescents completed surgery (“completers”) or withdrew from treatment (“non-completers”).

Setting

Adolescents were from a bariatric surgery program within a pediatric tertiary care hospital.

Methods

A retrospective chart review was conducted of consecutive patients who completed bariatric surgery psychological intake evaluations from September 2009 to April 2013. Data involving completer (n = 61) versus non-completer (n = 65) status were analyzed using two-tailed independent t tests, Chi-squared tests, and logistic regressions.

Results

Forty-three percent of adolescents completed surgery, similar to adult bariatric samples. Significantly more males were non-completers (p < .05), and there was a trend towards non-completion for older adolescents (p = 0.06). No other demographic, psychological, or caregiver/family variables were significant predictors of non-completion.

Conclusions

These findings indicate that demographic variables, rather than psychological or family factors, were associated with the progression to or withdrawal from surgery. Further assessment is needed to determine specific reasons for completing or withdrawing from treatment, particularly for males and older adolescents, to improve clinical care and reduce attrition.

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References

  1. Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches. A scientific statement from the American Heart Association. Circulation. 2013;128:1689–712. https://doi.org/10.1161/CIR.0b013e3182a5cfb3.

    Article  Google Scholar 

  2. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity. 2016;24(5):1116–23. https://doi.org/10.1002/oby.21497.

    Article  Google Scholar 

  3. Inge TH, Boyce TW, Lee M, et al. Access to care for adolescents seeking weight loss surgery. Obesity. 2014;22:2593–7. https://doi.org/10.1002/oby.20898.

    Article  Google Scholar 

  4. Woolford SJ, Clark SJ, Sallinen BJ, et al. Bariatric surgery decision making challenges: the stability of teens’ decisions and the treatment failure paradox. PediatrSurgInt. 2012;28:455–60. https://doi.org/10.1007/s00383-012-3069-7.

    Article  Google Scholar 

  5. Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. SurgObesRelat Dis. 2010;6:8–15. https://doi.org/10.1016/j.soard.2009.07.003.

    Article  Google Scholar 

  6. Sockalingam S, Cassin S, Crawford SA, et al. Psychiatric predictors of surgery non-completion following suitability assessment for bariatric surgery. ObesSurg. 2013;23:205–11. https://doi.org/10.1007/s11695-012-0762-5.

    Article  CAS  Google Scholar 

  7. Merrell J, Ashton K, Windover A, et al. Psychological risk may influence drop-out prior to bariatric surgery. SurgObesRelat Dis. 2012;8:463–9. https://doi.org/10.1016/j.soard.2012.01.018.

    Article  Google Scholar 

  8. Grave R, Calugi S, Molinari E, et al. Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obes Res. 2005;13:1961–9. https://doi.org/10.1038/oby.2005.241.

    Article  Google Scholar 

  9. Grossi E, Dalle Grave R, Mannucci, et al. Complexity of attrition in the treatment of obesity: clues from a structured telephone interview. Int J Obesity. 2006;30:1132–7. https://doi.org/10.1038/sj.ijo.0803244.

    Article  CAS  Google Scholar 

  10. Moroshko I, Brennan L, O'Brien P. Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev. 2011;12:912–34. https://doi.org/10.1111/j.1467-789x.2011.00915.x.

    Article  CAS  Google Scholar 

  11. Zeller M, Kirk S, Claytor R, et al. Predictors of attrition from a pediatric weight management program. J Pediatr. 2004;144:466–70. https://doi.org/10.1016/j.jpeds.2003.12.031.

    Article  Google Scholar 

  12. Cohen MJ, Curran JL, Phan TT, et al. Psychological contributors to noncompletion of an adolescent preoperative bariatric surgery program. SurgObesRelat Dis. 2017;13(1):58–64. https://doi.org/10.1016/j.soard.2016.08.020.

    Article  Google Scholar 

  13. Zeller MH, Reiter-Purtill J. Psychosocial issues in adolescent bariatric surgery. In: The ASMBS Textbook of Bariatric Surgery. New York: Springer; 2014. p. 65–73. https://doi.org/10.1007/978-1-4939-1197-4_8.

    Chapter  Google Scholar 

  14. Skelton JA, Goff DC, IP E, et al. Attrition in a multidisciplinary pediatric weight management clinic. Childhood Obesity. 2011;7(3):185–93. https://doi.org/10.1089/chi.2011.0010.

    Article  Google Scholar 

  15. Schor EL. Family pediatrics: report of the task force on the family. Pediatrics. 2003;111:1541–71.

    Google Scholar 

  16. Skelton JA, Buehler C, Irby MB, et al. Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management. Int J Obes. 2012;36(7):891–900. https://doi.org/10.1038/ijo.2012.56.

    Article  CAS  Google Scholar 

  17. Zeller MH, Hunsaker S, Mikhail C, et al. Family factors that characterize adolescents with severe obesity and their role in weight loss surgery outcomes. Obesity. 2016;24:2562–9. https://doi.org/10.1002/oby.21676.

    Article  Google Scholar 

  18. Skelton J, Beech B. Attrition in pediatric weight management: a review of the literature and new directions. Obes Rev. 2011;12:e273–81. https://doi.org/10.1111/j.1467-789x.2010.00803.x.

    Article  CAS  Google Scholar 

  19. Gundersen, C, Mahatmya D, Garasky S, Lohman, B. Linking psychosocial stressors and childhood obesity. Obes Rev 2010; 12: e54-e63. https://doi.org/10.1111/j.1467-789x.2010.00813.x.

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, revised. 4th ed.Washington DC: American Psychiatric Association; 2000. https://doi.org/10.1007/springerreference_179660.

  21. Statistics IS SPSS version 21.0 for Microsoft windows platform. SPSS Inc.: Chicago, IL, USA, 2012.

  22. Muthén LK, Muthén BO. Mplus version 7: Los Angeles, Muthén & Muthén; 1998-2014.

  23. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17. https://doi.org/10.1001/jama.294.15.1909

    Article  CAS  Google Scholar 

  24. Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–71. https://doi.org/10.1001/jamasurg.2013.1048

    Article  Google Scholar 

  25. VerbruggeLM SRP. Physician treatment of men and women patients: sex bias or appropriate care? Med Care. 1981;19:609–32. https://doi.org/10.1097/00005650-198106000-00005

    Article  Google Scholar 

  26. Tudiver F, Talbot Y. Why don’t men seek help? Family physicians’ perspective on help-seeking behavior in men. J Family Pract. 1999;48:47–52.

    CAS  Google Scholar 

  27. McQuaid EL, Kopel SJ, Klein RB, et al. Medication adherence in pediatric asthma: reasoning, responsibility, and behavior. J Pediatr Psychol. 2003;28:323–33. https://doi.org/10.1093/jpepsy/jsg022

    Article  Google Scholar 

  28. Slotman GJ. Gastric bypass: a family affair—41 families in which multiple members underwent bariatric surgery. SurgObesRelat Dis. 2011;7:592–8. https://doi.org/10.1016/j.soard.2011.04.230

    Google Scholar 

  29. Zeller MH, Guilfoyle SM, Reiter-Purtil J, et al. Adolescent bariatric surgery: caregiver and family functioning across the first postoperative year. SurgObesRelat Dis. 2011;7:145–50. https://doi.org/10.1016/j.soard.2010.07.004

    Google Scholar 

  30. Inge TH, Zeller MH, Harmon CM, et al. Teen-longitudinal assessment of bariatric surgery: methodological features of the first prospective multicenter study of adolescent bariatric surgery. J PediatrSurg. 2007;42:1969–71. https://doi.org/10.1016/j.jpedsurg.2007.08.010

    Google Scholar 

  31. Sawhney P, Modi AC, Jenkins TM, et al. Predictors and outcomes of adolescent bariatric support group attendance. SurgObesRelat Dis. 2013;9:773–9. https://doi.org/10.1016/j.soard.2013.03.016

    Google Scholar 

  32. Cote MP, Byczkowski T, Kotagal U, et al. Service quality and attrition: an examination of a pediatric obesity program. Int J Qual Health Care. 2004;16(2):165–73. https://doi.org/10.1093/intqhc/mzh015

    Article  Google Scholar 

  33. Kitscha CE, Brunet K, Farmer A, et al. Reasons for non-return to a pediatric weight management program. Can J Diet Prac Res. 2009;70(2):89–94. https://doi.org/10.3148/70.2.2009.89.

    Article  Google Scholar 

  34. Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. SurgObesRelat Dis. 2016;12(4):731–49. https://doi.org/10.1016/j.soard.2016.02.008

    Google Scholar 

  35. Kizy S et al. National trends in bariatric surgery 2012–2015: demographics, procedure selection, readmissions, and cost. Obes Surg. 2017;27(11):2933–9. https://doi.org/10.1007/s11695-017-2719-1.

    Article  Google Scholar 

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Acknowledgments

We acknowledge Linda Kollar, RN, MSN, CBN, Cassandra McDaniel, BA, Kathy Hrovat, MS, RD, LD, and Taylor Howarth, BA, for their contributions to this work.

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Authors and Affiliations

  1. Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV, 26505, USA

    Cassie Brode

  2. Atlanta, GA, USA

    Megan Ratcliff

  3. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jennifer Reiter-Purtill, Sanita Hunsaker & Meg Zeller

  4. Department of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Michael Helmrath

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  1. Cassie Brode
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  2. Megan Ratcliff
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  6. Meg Zeller
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Corresponding author

Correspondence to Cassie Brode.

Ethics declarations

The current study received Institutional Review Board approval.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Formal consent is not required for data collection as part of routine clinical practice.

Statement of Human and Animal Rights

This study received institutional review board approval. All procedures performed were in accordance with institutional and national ethical standards of studies involving human participants.

Funding Agency

The first author was supported by a training grant from the National Institutes of Health (T32DK063929).

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Brode, C., Ratcliff, M., Reiter-Purtill, J. et al. Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery. OBES SURG 28, 2853–2859 (2018). https://doi.org/10.1007/s11695-018-3261-5

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  • DOI: https://doi.org/10.1007/s11695-018-3261-5

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