Adolescent Bariatrics: Assessing Health Benefits & Risks

描述(由申请人提供)： 摘要：减肥手术是治疗成人极端肥胖的有效方法，在第五个十年最常用。随着越来越多的青少年患上极端肥胖并寻求减肥手术，我们的长期目标是阐明手术减肥对青少年健康的好处和风险。我们的中心假设是，青春期的严重肥胖与医学和心理社会障碍有关，而青春期的手术治疗可能比成年后的手术更有效。这是基于我们的观察得出的结论：1)接受减肥手术的青少年有明显和隐蔽的医疗合并症，并且已经发展出可能恶化的心理社会问题，2)减肥手术后体重显著减轻，以及3)一些严重肥胖相关状况的改善，如代谢综合征、阻塞性睡眠呼吸暂停、抑郁症和生活质量的改善。然而，青少年对处方医疗方案的依从性可能很差，并可能对青春期进行的减肥手术的有益结果产生不利影响。因此，这项提议的目的是首次阐明青春期实施减肥手术与成年后实施减肥手术的替代手术相比的益处和预期的并发症。我们的具体目标是：确定寻求减肥手术的青少年和成年人之间的关键健康指标是否有显著差异，并确定在一生中较早而不是较晚地进行减肥手术是否有与年龄相关的健康益处；2)确定接受减肥手术的青少年和成年人的健康风险；3)记录极端肥胖青少年和成年人减肥手术前后的心理社会状况。青少年将从几个数量较大的青少年减肥中心招募，并从参与减肥手术纵向评估(Lab)的成人减肥中心招募比较队列。通过比较代谢综合征、睡眠呼吸暂停指数、并发症、营养状况、方案依从性和心理社会状况的特点，我们将开始了解以肥胖持续时间为调节变量的减肥手术的医疗和心理健康结果。这种比较将导致更好地理解严重肥胖者生命过程中与肥胖相关的重要医学和心理社会共病的可塑性。通过定义青少年人群中的风险，这些数据将为为健康日益受到极端肥胖威胁的美国年轻人提供适当手术时机的科学决策提供宝贵的信息。

DESCRIPTION (provided by applicant): Abstract: Bariatric surgery is effective in treating extreme obesity in adults, and is most commonly used in the 5th decade. As more teenagers develop extreme obesity and seek bariatric surgery, our long term goal is to elucidate the health benefits and risks of surgical weight loss for adolescents. Our central hypothesis is that severe obesity in adolescence is associated with medical and psychosocial impairments which may be more effectively treated with surgery during adolescence rather than later in adulthood. This is based on our observations that adolescents presenting for bariatric surgery 1) have overt and occult medical comorbidities and have already developed psychosocial problems which are likely to worsen, 2) lose significant weight following bariatric surgery, and 3) experience improvement in a number of serious obesity-related conditions such as features of the metabolic syndrome, obstructive sleep apnea, depression, and quality of life. However, compliance by adolescents with prescribed medical regimens can be poor and may adversely affect beneficial outcomes of bariatric surgery performed in adolescence. Thus, the purpose of this proposal is to elucidate for the first time benefits and define complications to be expected when bariatric surgery is performed in adolescence compared to the alternative, bariatric surgery in adulthood. Our Specific Aims are: To determine whether key health indicators significantly differ between adolescents and adults seeking bariatric surgery and determine whether there is an age-related health benefit in performing bariatric surgery earlier rather than later in the lifetime; 2) To identify health risks for adolescents and adults undergoing bariatric surgery; 3) To document the psychosocial status of adolescents and adults with extreme obesity before and after bariatric surgery. Adolescents will be recruited from several high volume adolescent bariatric centers and a comparison cohort from adult bariatric centers participating in the Longitudinal Assessment of Bariatric Surgery (LABS). By comparison of features of the metabolic syndrome, sleep apnea indices, complications, nutritional status, regimen adherence, and psychosocial status, we will begin to understand medical and psychological health outcomes of bariatric surgery using obesity duration as a moderating variable. This comparison will lead to a better understanding of the plasticity of important medical and psychosocial obesity-related comorbidities in the life-course of those with severe obesity. By also defining risks in the adolescent population, these data will be invaluable for scientifically informing decision-making regarding appropriate timing of surgery for young Americans whose health is increasingly threatened by extreme obesity.