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育时期，其特点是出现精神健康障碍和高危行为，成为重大的公共卫生问题。有些人在这些时期相对毫发无损，而另一些人则在不同的健康，心理社会风险和能力的轨道上起步。随着减肥手术（WLS）成为重度肥胖青少年（BMI>40 kg/m2）的可行治疗方法，必须确定青少年WLS患者在术后过程中的独特需求，因为他们经历了这些关键的转变。迄今为止，WLS临床护理模式依赖于成人经验。因此，预防/干预工作的关键目标和时间安排，以优化青少年的成果，并随着他们的成熟，在很大程度上仍然没有确定。与NIDDK的青少年减肥手术纵向评估联盟合作（Teen-LABS; UM 1 DK 072493，PI：Inge），PI的辅助TeenView（R01DK080020; PI：Zeller）是第一项前瞻性、对照性、观察性研究，研究了与青少年严重肥胖和WLS结果相关的年龄显著性心理社会健康和风险（6、12和24个月）。初步数据显示，术后体重和生活质量的改善令人印象深刻，尽管有些患者开始在24个月和中期（48个月）开始下降。虽然少数青少年术前存在临床范围的精神病理学和/或儿童不良史，但这些术前因素的存在使患者（如任何青少年）处于更大的心理社会风险轨迹上，以及短期内可变的体重减轻结局。青少年WLS患者在24个月内也从低风险行为率迅速发展到更“规范”甚至“不协调”的水平，初步证据表明物质使用和体重变化之间存在联系。考虑到成人WLS文献与术后精神病理学和体重减轻结局、酒精滥用/依赖的出现以及自杀死亡风险增加有关，因此对青少年WLS患者的关注度更高。拟定的辅助研究“VIEWpoint”是对TeenView的延续（更新）应用，将早期术后结局的初步观察扩展至成年早期和术后6年时间点，此时体重减轻的持久性进一步分化，但心理健康和风险完全未知。VIEWpoint目标通过以下方式得到增强：（1）TeenView基础的相关早期青少年心理社会因素/背景可能有助于解释从手术到年轻成人心理社会结局的途径，以及（2）建立TeenView非手术、人口统计学相似、严重肥胖的对照组，自青春期起平行随访。这项严谨而新颖的科学将利用现有队列的大量投资，进一步阐明最佳与次佳WLS结局的关键因素，这些信息对于告知年龄突出的患者护理来说既及时又迫切需要。

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.