Partnering lifestyle intervention with bariatric surgery to maximize health outcomes in adolescents

项目总结 严重肥胖，定义为体重指数第95个百分位数的120%，根据年龄和性别或≥进行调整 体重指数35公斤/平方米是美国儿科人口中增长最快的肥胖子类别。 大约9%的12-19岁青少年患有严重肥胖症，是1988-1994年患病率的三倍。甚至更多 关于，近12%的非西班牙裔黑人和9%的西班牙裔12-19岁的青少年患有严重肥胖症 相比之下，非西班牙裔白人的这一比例为7%。代谢和减肥手术(MBS)被证明是 安全有效地治疗患有严重肥胖症的青少年(定义为13-18岁)。还没有 全国青少年MBS比率的增长速度没有达到严重肥胖症流行的速度，而且 短期和长期自然减员(那些符合条件但没有坚持执行MBS的人和那些没有回来的人 对于MBS后的护理)在这一患者群体中仍然是一个巨大的挑战。或者，减肥 住院和门诊环境中的行为/生活方式和药物治疗方案没有 报告了类似的持续减肥轨迹，特别是在长期内。行为/生活方式方案 教授必要的改变以维持成功的减肥，但没有标准化的前后对照 为青少年MBS患者提供的支持这些行为变化的操作性生活方式干预。 因此，我们提出了以下混合方法的具体目标：目标1.生成必要的定性数据以 适应现有循证健康生活方式行为干预的内容、策略和实施 明确支持MBS前和MBS后的方法，种族多样化(非西班牙裔白人和黑人；西班牙裔， 其他)、青少年患者及其家属。这项形成性研究将包括焦点小组和关键 线人采访青少年、父母和临床团队成员。目标2.适应健康的生活方式 行为干预(在AIM 1中引用)，由AIM 1数据(和分析)提供信息，以支持预和 在不同种族的青少年患者及其家人中开展后MBS。目标3.进行概念验证 评估MBS支持的健康生活方式行为的可行性、可接受性和有效性的研究 对青少年患者、他们的家人和他们的临床团队进行干预(适用于AIM 2)。我们会 反复分析AIM 1定性数据，直到从后面的访谈/讨论中没有出现新的概念， 而由此产生的主题被数据分析师认为是“饱和的”。这项研究的结果将为 未来一项随机对照试验的开发，以测试住房抵押贷款证券化-生活方式干预(S)与 关心。

PROJECT SUMMARY Severe obesity, defined as ≥ 120% of the 95th percentile of body mass index (BMI) adjusted for age and sex or a BMI >35 kg/m2 is the fastest growing subcategory of obesity in the United States (US) pediatric population. Approximately 9% of 12-19 year-olds have severe obesity, triple the prevalence in 1988-1994. Even more concerning, almost 12% of Non-Hispanic Black and 9% of Hispanic adolescents ages 12-19 have severe obesity compared to 7% of their non-Hispanic white counterparts. Metabolic and bariatric surgery (MBS) is shown to be safe and efficacious in treating adolescents (defined as ages 13-18 for this application) with severe obesity. Yet national adolescent MBS rates have not increased at the same rate of that of the severe obesity epidemic, and short-and long-term attrition (those who qualify but do not follow through with MBS and those who do not return for care after MBS) remains a significant challenge in this patient population. Alternatively, weight-loss behavioral/lifestyle and pharmacotherapy treatment programs in inpatient and ambulatory settings have not reported similar sustained weight loss trajectories, particularly in the long-term. Behavioral/lifestyle programs teach the necessary modifications to sustain successful weight loss, but there is no standardized pre-and post- operative lifestyle intervention that is offered to adolescent MBS patients to support these behavioral changes. As such, we propose the following mixed methods specific aims: AIM 1. Generate qualitative data necessary to adapt an existing evidence-based healthy lifestyle behavioral intervention’s content, strategies and delivery methods to explicitly support pre- and post-MBS, ethnically diverse (non-Hispanic white and black; Hispanic, other), adolescent patients and their families. This formative research will include focus groups, and key informant interviews with adolescents, parents, and clinical team members. AIM 2. Adapt the healthy lifestyle behavioral intervention (referenced in AIM 1), as informed by AIM 1 data (and analyses), to support pre-and post-MBS among ethnically diverse adolescent patients and their families. AIM 3. Conduct a proof-of-concept study to assess feasibility, acceptability and effectiveness of an MBS-supported healthy lifestyle behavioral intervention (adapted in AIM 2) among adolescent patients, their families, and their clinical team. We will iteratively analyze the AIM 1 qualitative data until no new concepts emerge from later interviews/discussions, and the resulting themes are considered “saturated” by the data analysts. Results from this study will inform the development of a future randomized controlled trial to test the MBS-lifestyle intervention(s) versus standard of care.