ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Lancet Child Adolesc Health. 2020;4(3):210–19. PMID 31978372.

In this non-randomized matched-control study, 81 obese adolescents undergoing Roux-en-Y gastric bypass surgery (RYGB) who participated in the Adolescent Morbid Obesity Surgery (AMOS) study (11) were compared with 80 obese controls from the Swedish Childhood Obesity Treatment Register (BORIS) who received conventional obesity treatment (12).

Concerning psychiatric drug treatment, no significant between-group difference was found at baseline or during 5-year follow-up. However, both groups showed increases over time in psychiatric medication. Whereas there was no between-group difference in treatment for psychiatric disorder at baseline, RYGB adolescents received significant more mental health treatment than controls during the 5 years post-surgery.

Self-reported mental health and binge eating were assessed in the surgical group by questionnaires, showing small but significant improvements in self-esteem and activation, and moderate improvements in binge eating 5 years after surgery, but no changes in overall mood, pleasantness or calmness. Patients with a better overall mood and higher self-esteem at 2-year follow-up had a higher percentage reduction in BMI at 5-year follow-up.

Although limited by a relatively small sample size and non-randomized groups, this study gives important insights in the mental health of adolescents over a long time after bariatric surgery, thereby reflecting the importance of ongoing assessments of mental status in this patient group. There is an unmet need for mental health services for adolescents with severe obesity whether they receive bariatric surgery or not. The suggestion that surgical weight management would improve mental health outcomes requires caution.

In contrast to physical and metabolic health benefits of bariatric surgery (1–4) and mental health problems of obese adolescents (5–7), little is known about the long-term course of mental health in adolescents with severe obesity who have undergone bariatric surgery (8–10). Therefore, the current paper, depicting specific mental health outcomes during 5 years follow-up in adolescents after bariatric surgery, is of great importance.

References:

1. Armstrong SC, Bolling CF, Michalsky MP, et al. Pediatric metabolic and bariatric surgery: evidence, barriers, and best practices.Pediatrics, 2019;144 (6):e20193223.

2. Inge TH, Jenkins TM, Xanthakos SA, et al. Long-term outcomes of bariatric surgery in adolescents with severe obestiy (FABS5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5 (3):165–173.

3. Shoar S, Mahmoudzadeh H, Naderan M, et al. Long-term outcome of bariatric surgery in morbidly obese adolscents: a systematic review and meta-analysis of 950 patients with a minimum of 3 years follow-up. Obes Surg. 2017;27 (12):3110–3117.

4. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents.N Engl J Med ; 2016;374:113–23.

5. Lindberg L, Hagman E, Danielsson E, Marcus C, Persson M. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Med. 2020;18 (1):30.

6. Deber H, Reynisdottir S, Anglin B, Hemmingsson E. Who is the treatment-seaking young adult with severe obesity: a comprehensive characterization with emphasis on mental health. PLos One 2015;10 (12):e0145273.

7. Quek YH, Tam WWS, Zhang MWB, Ho RCM. Exploring the association between childhood and adolescent obesity and depression: a meta-analysis. Obes Rev. 2017;18 (7):742–54. 10.1111/obr.12535.

8. Herget S, Rudolph A, Hilbert A, Bluher S. Psychosocial staus and mental health in adolescents before and after bariatric surgery: a systematic literature review. Obes Facts 2014;7,233–245.

9. Järvholm K, Karlsson J, Olbers T, et al. Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity. Obesity 2015;23:1966–72.

10. Neovius M, Bruze G, Jacobson P, Sjöholm K, Johansson K, et al. Risk of Suicide and Non-Fatal Self-Harm After Bariatric Surgery: Results From Two Matched Cohort Studies. Lancet Diabetes Endocrinol. 2018;6 (3):197–207.

11. Olbers T, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocroninol. 2017;5:174–183.12. Hagman E, Danielsson P, Lindberg L, Marcus C, et al. Paediatric obesity treatment during 14?years in Sweden: Lessons from the Swedish Childhood Obesity Treatment Register-BORIS. Pediatr Obes. 2020;15 (7):e12626.