Adolescent Bariatrics: Controlled Longitudinal Study of Psychosocial Development

描述(由申请人提供)：合作研究人员与NIDDK工作人员合作，最近创建了一个四中心外科研究联盟，减肥手术或青少年实验室的青少年纵向评估(U01 DK072493)。作为一项前瞻性的纵向减肥队列观察研究，青少年实验室的最初目标是反映成人外科研究联盟(减肥手术纵向评估)(实验室)的关键数据收集要素，以记录青少年减肥手术的安全性以及手术后6、12和24个月的健康结果与成人结果的比较。青少年减肥手术发生在心理社会发展的一个重要时期--情感、人际、社会和职业/职业领域的快速变化时期，在这一时期，良好的适应预示着在过渡到新的成年期(18-20岁)时继续积极适应。减肥手术有可能积极改变极端肥胖青少年的心理社会和由此产生的发展轨迹。按照目前的设计，青少年实验室不考虑青少年患者的年龄-突出的心理社会和发展范式，并且缺乏青少年非手术对照群体-关键差距对于阐明手术在这一独特发育阶段的风险和好处至关重要。为了解决这些差距，这项对青少年实验室的辅助研究将采用前瞻性、可控性、纵向设计，并在相同的时间段内跟踪两个平行的青少年队列：170名青少年实验室参与者(14-18岁)和236名从两个青少年实验室网站招募的人口统计学匹配的非手术极端肥胖青少年。两组患者都将在基线/术前以及术后头两年内的不同时间点完成一系列措施。除了已经在青少年实验室方案中评估的数据元素(BMI、抑郁症状、暴饮暴食、生活质量)，本研究还将记录手术对年龄突出的青少年心理社会功能的其他领域(例如，感知能力、同伴受害、社会支持、身体形象)以及可能解释心理社会功能个体差异的因素(父母/家庭功能受损、健康风险行为、高危环境)的积极影响。此外，辅助研究将为青少年实验室增加一项至关重要的24个月结果衡量标准--成年初期(18-20岁)年龄显著的发展任务的完成情况(即学术成就、工作能力、社交/恋爱参与度)。人口统计学上匹配的非手术极端肥胖对照组的增加将提供有关青少年极端肥胖自然过程的重要信息--在这个背景下，评估减肥手术对极端肥胖青少年的长期心理社会和发育健康的相对影响。因此，拟议研究的创新目标和研究设计将显著提高青少年实验室的科学贡献。

DESCRIPTION (provided by applicant): Co-Investigators, in cooperation with NIDDK staff, recently created a four-center surgical research consortium, the Teen-Longitudinal Assessment of Bariatric Surgery or Teen-LABS (U01 DK072493). Designed as a prospective, longitudinal bariatric cohort observational study, the initial aims of Teen-LABS are to mirror key data collection elements of the adult surgical research consortium (Longitudinal Assessment of Bariatric Surgery) (LABS) to document the safety of bariatric surgery in adolescence and the post-operative health outcomes at 6, 12- and 24-months as compared to adult outcomes. Adolescent bariatric surgery occurs at an important time in psychosocial development-a period of rapid change in emotional, interpersonal, social, and career/vocational domains in which good adaptation bodes well for continued positive adaptation in the transition to emerging adulthood (ages 18-20). Bariatric surgery has the potential to positively alter the psychosocial and resultant developmental trajectory of adolescents with extreme obesity. As currently designed, Teen-LABS does not consider the adolescent patient within age-salient psychosocial and developmental paradigms and lacks an adolescent non-operative comparative group-critical gaps important to elucidating the risks and benefits of surgery during this unique developmental stage. To address these gaps, this ancillary study to Teen-LABS will utilize a prospective, controlled, longitudinal design and follow two parallel cohorts of adolescents over the same course of time: 170 Teen-LABS participants (ages 14-18) and 236 demographically matched non-operative extremely obese adolescents recruited from two Teen-LABS sites. Both cohorts will complete a series of measures at baseline/pre-surgery and at various time-points within the first 2 years post surgery. In addition to data elements already assessed within the Teen-LABS protocol (BMI, depressive symptoms, binge eating, quality of life), the present study will document the positive impact of surgery on additional domains of age-salient adolescent psychosocial functioning (e.g., perceived competence, peer victimization, social support, body image) and factors that may account for individual variations in psychosocial functioning (impaired parent/family functioning, health risk behaviors, high risk contexts). In addition, the ancillary study will add a critically important 24-month outcome measure to Teen-LABS-the attainment of age-salient developmental tasks of emerging adulthood (ages 18-20) (i.e., academic attainment, work competence, social/romantic involvement). The addition of a demographically matched non-operative extremely obese comparison group will provide vital information regarding the natural course of adolescent extreme obesity-a context in which to evaluate the relative impact of bariatric surgery on the long-term psychosocial and developmental well being of extremely obese adolescents. Hence, the innovative aims and research design of the proposed study will significantly enhance the scientific contribution of the Teen-LABS.