Adolescent Bariatric Surgery: Weight and Psychosocial Risk in Young Adulthood

描述（由申请人提供）：青春期和向青年期的过渡是一个发展时期，其特点是精神健康障碍和高风险行为的出现，这是重大的公共卫生问题。有些人相对毫发无损地度过了这些时期，而另一些人则走上了不同的健康、社会心理风险和能力的轨道。随着减肥手术（WLS）成为严重肥胖青少年（BMI为40 kg/m2）的可行治疗方法，确定青少年WLS患者在术后经历这些关键转变时的独特需求是必要的。迄今为止，WLS的临床护理模式依赖于成人的经验。因此，预防/干预工作的关键目标和时机，以优化青少年的结果，并随着他们的成熟，在很大程度上仍然不确定。与NIDDK的青少年减肥手术纵向评估联盟（Teen-LABS; UM1 DK072493, PI: Inge）合作，PI的辅助TeenView （R01DK080020; PI: Zeller）是第一个前瞻性、对照、观察性研究，研究青少年严重肥胖和短期（6、12和24个月）WLS结果的年龄显著性心理健康和风险。初步数据显示，术后体重和生活质量的改善令人印象深刻，尽管有些患者在24个月和中期（48个月）开始下降。虽然少数青少年在术前表现出临床范围的精神病理和/或儿童逆境史，但这些术前因素的存在使患者（就像任何青少年一样）处于更大的社会心理风险的轨道上，以及短期内可变的体重减轻结果。青少年WLS患者也会在24个月大时从低风险行为率迅速发展到更“规范”甚至“不正常”的水平，并有初步证据表明药物使用与体重变化之间存在联系。鉴于成人WLS文献将术后精神病理和体重减轻结果、酒精滥用/依赖的出现以及自杀死亡风险的增加联系起来，青少年WLS患者的担忧得到了加强。拟议的辅助研究“VIEWpoint”是TeenView的延续（更新）申请，将把早期术后结果的初始观点扩展到年轻成年期和术后6年时间点，此时体重减轻的持久性已进一步分化，但心理健康和风险完全未知。(1)青少年早期相关心理社会因素/背景的TeenView基础可能有助于解释从手术到青年社会心理结果的途径；(2)建立了一个非手术的、人口统计学上相似的严重肥胖对照组，从青春期开始平行随访。这门严谨而新颖的科学将利用对现有队列的大量投资，进一步阐明最佳与次优WLS结果的关键因素，及时和迫切需要的信息为年龄突出的患者护理提供信息。

DESCRIPTION (provided by applicant): Adolescence and the transition to young adulthood is a developmental period distinguished by the emergence of mental health disorders and high-risk behaviors as significant public health concerns. Some individuals navigate these periods relatively unscathed, while others are launched on trajectories of varying health, psychosocial risk and competence. As weight loss surgery (WLS) emerges as a viable treatment for adolescents with severe obesity (BMI>40 kg/m2), it is imperative to identify the unique needs of the adolescent WLS patient across the post-operative course as they pass through these critical transitions. To date, WLS clinical care models are reliant on the adult experience. As such, critical targets and timing of prevention/ intervention efforts to optimize outcomes for the adolescent and as they mature remain largely undefined. In cooperation with the NIDDK's Teen-Longitudinal Assessment of Bariatric Surgery consortium (Teen-LABS; UM1 DK072493, PI: Inge), the PI's ancillary TeenView (R01DK080020; PI: Zeller) is the first prospective, controlled, observational study examining age-salient psychosocial health and risk associated with adolescent severe obesity and WLS outcomes in the short-term (6, 12, and 24-months). Preliminary data reveal post- operative improvements in weight and quality of life that are impressive, although for some patients begin to diminish by 24-months and into the mid-term (48-months). While a minority of adolescents present pre- surgically with clinical range psychopathology and/or a history of child adversities, the presence of these pre- surgical factors place patients (as they would any adolescent) on a trajectory of greater psychosocial risk, as well as variable weight loss outcomes in the short-term. Adolescent WLS patients also progress quickly from low rates of high-risk behaviors to more "normative" or even "inordinate" levels by 24-months, with initial evidence of links between substance use and weight change. The concern is heightened for the adolescent WLS patient given the adult WLS literature links post-operative psychopathology and weight loss outcomes, the emergence alcohol abuse/dependence, and increased risk of death by suicide. The proposed ancillary study "VIEWpoint", a continuation (renewal) application to TeenView, will extend the initial view of early post- operative outcomes to young adulthood and at the 6-year postoperative time-point, when durability of weight loss has further differentiated, yet psychosocial health and risk is entirely unknown. VIEWpoint aims are enhanced by (1) the TeenView foundation of relevant earlier adolescent psychosocial factors/contexts that may help explain the pathway from surgery to young adult psychosocial outcomes, and (2) an established TeenView non-operative, demographically similar, severely obese comparison group followed in parallel since adolescence. This rigorous and novel science will capitalize on the considerable investment in existing cohorts to further elucidate key contributors to optimal versus suboptimal WLS outcomes, information that is both timely and critically needed to inform age-salient patient care.