Abstract
Purpose
Criteria for adolescent bariatric surgery include failure of ≥6 months of organized weight loss attempts. We wished to explore whether adolescents, initially wanting surgery, change their mind during a 6-month weight loss program and how many meet the treatment failure criterion.
Methods
A retrospective chart review of adolescents enrolled in a weight loss program between 3/2007 and 2/2009.
Results
Twenty-one (13 % of total patients) initially wanted bariatric surgery. Most were Medicaid enrollees (70 %), female (85 %), and white (60 %). The mean age was 15 years and mean BMI was 51 (range 36–71). Five did not meet BMI, comorbidity, or psychological criteria for surgery. Eight lost weight and therefore did not meet the treatment failure criterion. Of these, seven no longer wanted surgery. Eight did not lose weight and therefore met the treatment failure criterion; five of these decided against surgery due to difficulty in making recommended lifestyle changes.
Conclusion
Most patients initially wanting bariatric surgery changed their minds. The treatment failure criterion presented a paradox, because most patients who met the criterion exhibited difficulty in making the lifestyle changes. To aid provider/patient decisions about bariatric surgery, further work should explore the criteria for surgery and stability of adolescents’ decisions regarding bariatric surgery.
Similar content being viewed by others
References
Ogden CL, Flegal KM, Carroll MD, Johnson CL (2002) Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 288(14):1728–1732
Strauss RS, Pollack HA (2001) Epidemic increase in childhood overweight, 1986–1998. JAMA 286(22):2845–2848
Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL (1995) Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 149(10):1085–1091
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291(23):2847–2850
Ogden CL, Carroll MD, Curtin LR et al (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295(13):1549–1555
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KH (2010) Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 303(3):242–249
Jolliffe D (2004) Extent of overweight among US children and adolescents from 1971 to 2000. Int J Obes Relat Metab Disord 28(1):4–9
Sjöström L, Narbro K, Sjöström CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752
Sjöström L, Lindroos A-K, Peltonen M et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693
Tsai AG, Asch DA, Wadden TA (2006) Insurance coverage for obesity treatment. J Am Diet Assoc 106(10):1651–1655
Fried M, Ribaric G, Buchwald JN et al (2010) Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m2: an integrative review of early studies. Obes Surg 20(6):776–790
Lawson ML, Kirk S, Mitchell T, Chen MK, Loux TJ, Daniels SR, Harmon CM, Clements RH, Garcia VF, Pediatric Bariatric Study Group (2006) One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg 41(1):137–143
Sugerman HJ, Sugerman EL, DeMaria EJ, Kellum JM, Kennedy C, Mowery Y, Wolfe LG (2003) Bariatric surgery for severely obese adolescents. J Gastrointest Surg 7(1):102–107
Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH, Lawlor DF, Marino MF, Meyers AF, Rosenblum JL, Sanchez VM (2009) Best practice updates for pediatric/adolescent weight loss surgery. Obesity 17(5):901–910
Davis MM, Slish K, Chao C, Cabana MD (2006) National trends in bariatric surgery, 1996–2002. Arch Surg 141(1):71–74
Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J (2008) National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J Am Coll Surg 206(1):1–12
Inge TH, Krebs NF, Garcia VF et al (2004) Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics 114(1):217–223
Woolford SJ, Sallinen BJ, Clark SJ, Freed GL (2011) Results from a clinical multidisciplinary weight management program. Clin Pediatr 50(3):187–191
Brownell KD (1998) Diet, exercise and behavioural intervention: the nonpharmacological approach. Eur J Clin Invest 28(Suppl 2):19–21
Epstein LH, Myers MD, Raynor HA, Saelens BE (1998) Treatment of pediatric obesity. Pediatrics 101(3 Pt 2):554–570
Ryan RM, Deci EL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55(1):68–78
Jeffery RW, Drewnowski A, Epstein LH et al (2000) Long-term maintenance of weight loss: current status. Health Psychol 19(1):5s–16s
Inge TH, Jenkins TM, Zeller M, Dolan L, Daniels SR, Garcia VF, Brandt ML, Bean J, Gamm K, Xanthakos SA (2010) Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr 156:103–108
Woolford SJ, Clark SJ, Gebremariam A, Davis MM, Freed GL (2010) To cut or not to cut: physicians’ perspectives on referring adolescents for bariatric surgery. Obes Surg 20(7):937–942
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Woolford, S.J., Clark, S.J., Sallinen, B.J. et al. Bariatric surgery decision making challenges: the stability of teens’ decisions and the treatment failure paradox. Pediatr Surg Int 28, 455–460 (2012). https://doi.org/10.1007/s00383-012-3069-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-012-3069-7