Bariatric Surgery in Adolescence: Psychosocial Outcomes

描述（由申请人提供）： 儿童肥胖症的日益流行已成为国家卫生保健的优先事项，由于整个生命周期的累积医疗和心理社会后果。肥胖的程度也以惊人的速度增加，使得严重肥胖的青少年（BMI >= 40 kg/m2）成为值得关注的人群。由于缺乏有效的治疗青少年肥胖症，特别是严重的肥胖症，外科干预措施，现在正在探索。成人减肥手术可显著减轻体重，并改善大多数与肥胖相关的合并症，包括改善情绪和生活质量。鉴于以前没有对寻求减肥手术的青少年进行过全面的研究，我们对这一独特人群的心理社会共病以及积极的短期和长期手术结果的预测因素的理解存在很大差距。我们的长期目标是通过确定成功的儿科体重管理的预测因素，显着改善肥胖青少年的健康和生活质量。本申请的主要目的是产生试点数据，以确定减肥手术在治疗严重肥胖青少年中的社会心理益处，并确定成功手术结局的社会心理预测因素，这是实现这一长期目标的重要下一步。这些试验数据将确定多中心R 01申报的拟定研究设计的可行性。本初步研究将评估符合严重肥胖标准（BMI>40 kg/m2）并接受减肥手术的肥胖青少年（13-17岁）的四个心理社会功能领域。这四个领域包括心理适应、暴饮暴食、生活质量和人际关系。对照组为寻求行为体重管理治疗的严重肥胖青少年。受试者将在治疗开始前以及治疗开始后6个月和12个月完成评估措施。识别与成功手术结果和长期维持体重减轻相关的青少年严重肥胖的心理社会相关性，对于制定更明智的患者选择标准和更有效的治疗模式至关重要。

DESCRIPTION (provided by applicant): The rising epidemic of pediatric obesity has become a national health care priority due to the cumulative medical and psychosocial consequences across the lifespan. The degree of obesity has also increased at an alarming rate making the severely obese adolescent (BMI >= 40 kg/m2}) a population for which there is notable concern. Given the paucity of effective treatment for adolescent obesity, and severe obesity in particular, surgical interventions are now being explored. Bariatric surgery in adults results in impressive weight loss and the improvement, if not resolution, of most obesity-related comorbidities, including improved mood and quality of life. Given that comprehensive study of adolescents seeking bariatric surgery has not previously been conducted there is a substantial gap in our understanding of the psychosocial comorbidities of this unique population and the predictors of positive short- and long-term surgical outcomes. Our long-term goals are to significantly improve the health and quality of life of youth who are obese through the identification of predictors of successful pediatric weight management. The primary objective of this application, which represents an important next step toward attainment of this long-term goal, is to generate pilot data to determine the psychosocial benefits of bariatric surgery in the treatment of severely obese adolescents as well as identify psychosocial predictors of successful surgical outcomes. These pilot data will establish feasibility of the proposed research design for a multi-site R01 submission. The present pilot study will assess four domains of psychosocial functioning in obese adolescents (ages 13-17) who meet criteria for severe obesity (BMI>40 kg/m}) and are referred for bariatric surgery. These four domains include psychological adjustment, binge eating, quality of life, and interpersonal relationships. Controls will be severely obese adolescents who have sought behavioral weight management treatment. Participants will complete the assessment measures prior to and at 6- and 12-months post-initiation of treatment. Identifying psychosocial correlates of severe obesity in adolescence associated with successful surgical outcomes and long-term maintenance of weight loss will be critical to the development of more informed patient selection criteria and more efficacious treatment paradigms.