Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes.

PURPOSE OF REVIEW: Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS: Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.

The impact of parental bariatric surgery and patient age on laparoscopic sleeve gastrectomy outcomes in adolescents.

BACKGROUND: Adolescent obesity is multifactorial, but parental history is the most significant risk factor. Laparoscopic sleeve gastrectomy (LSG) is part of the multidisciplinary approach to adolescent weight loss. OBJECTIVE: We aimed to evaluate the effects of parental history of bariatric surgery, as well as age at time of operation, on adolescents who underwent LSG at our institution. METHODS: We performed a retrospective review of patients, aged 10 to 19 years, who underwent LSG from January 2010 to December 2019. The adolescent bariatric surgical dataset maintained by our group was used to obtain patient demographics, weight, body mass index (BMI), and parental history of bariatric surgery. RESULTS: Among 328 patients, 76 (23.2%) had parents who had previously undergone bariatric surgery. These patients were significantly heavier by weight (p = 0.012) at the time of operation but had no difference in postoperative weight loss. When all patients were compared by age at operation (< 16 years, n = 102, ≥ 16 years, n = 226), there were few differences in outcomes. CONCLUSIONS: LSG is an effective approach to surgical weight loss in adolescents. Patient age should not be a barrier to weight loss surgery, especially among patients with a parental history of obesity. By intervening at a younger age, the metabolic sequelae of obesity may be reduced.

The current state of parent feeding behavior, child eating behavior, and nutrition intake in young children with type 1 diabetes.

BACKGROUND: One integral component of type 1 diabetes (T1D) management is attention to nutrition, which can be particularly challenging in young children. OBJECTIVE: The current study reports on parent and child eating/feeding behavior and nutrition intake as compared with current recommendations for pediatric T1D. SUBJECTS: Participants were 46 children ages 2 to 5 diagnosed with T1D and one parent. METHODS: The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to assess parent feeding and child eating behaviors. The Remote Food Photography Method (RFPM) was used to analyze nutrition intake at breakfast. Demographic and medical information were collected via self-report and medical chart review. RESULTS: In the current sample, 37% of BPFAS scores were above the cutoff for problem child eating behavior. Only 28% of participants met the recommended goals for glycemic control (hemoglobin A1c, HbA1c < 7.5). Children who did not meet glycemic control targets reported higher carbohydrate intake than those meeting targets. Protein recommendations were met by 46%; 22.7% met the recommendation for carbohydrate intake, and 45.5% met fat intake recommendations. The majority of the sample did not meet body mass index percentile (BMI%) recommendations with 51% having a BMI% above the 85th percentile. CONCLUSIONS: Many parents of young children with T1D report problem child eating behaviors. Further, a significant number of young children are not meeting glycemic, nutritional, or BMI guidelines for T1D. Routine screening for dietary difficulties in young children is warranted. Future research should aim to examine interventions targeting families with young children not meeting nutrition, glycemic, or BMI guidelines.

Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations.

The rising rates of severe obesity among adolescents in the United States indicate a dire need for more intensive weight management strategies. While current evidence suggests that bariatric surgery is a safe and efficacious intervention for adolescents, the linkages with psychopathology before and after surgery are not well understood. Psychologists are an integral part of the interdisciplinary surgery team and play an important role in preparing youth for bariatric surgery as well as supporting adolescents post-surgery. The present manuscript reviews the literature on psychopathology in the context of adolescent bariatric surgery, discusses consideration of psychopathology as a contraindication for surgery, and provides recommendations on how psychologist members of the bariatric surgery team may balance attention to motivation and adherence to medical recommendations with assessment and treatment of psychopathology. Finally, the importance of continued research to confirm clinical consensus regarding decision-making and expansion of psychological resources within adolescent bariatric surgery programs are discussed.

Impulse Control in Negative Mood States, Emotional Eating, and Food Addiction are Associated with Lower Quality of Life in Adolescents with Severe Obesity.

Objectives: Quality of life (QoL) is an important outcome to evaluate in adolescents with severe obesity, yet intrapersonal predictors of QoL are understudied. The current study assessed whether difficulty with impulse control when experiencing a negative mood (negative urgency) is associated with poorer QoL, mediated by more emotional eating and food addiction. Method: Participants consisted of 69 primarily female (71%), minority (76%) adolescents aged 13-21 (M age = 16.5, SD = 1.5) with severe obesity presenting for prebariatric surgery psychological evaluations. Structural Equation Modeling was used to appraise a model of the association of adolescent report of negative urgency with more emotional eating (Emotional Eating Scale for Children) and food addiction (Yale Food Addiction Scale) and poorer weight-related QoL (Impact of Weight on Quality of Life-Kids). Results: Greater difficulty controlling behavior when experiencing a negative mood was significantly associated with poorer weight-related QoL, and this relationship was mediated by an association with emotional eating and food addiction such that adolescents with severe obesity who reported more difficulties with impulse control in negative mood states were more likely to report more emotional eating and food addiction, which was in turn associated with lower QoL. Conclusions: Intrapersonal factors, including impulse control in negative mood states, are associated with lower QoL in adolescents with severe obesity. Interventions aimed at reducing frequency of negative affect, reducing impulsivity in negative mood states, and improving coping skills that are not eating based may contribute to improved QoL and merit further study.

Cognitive Performance as Predictor and Outcome of Adolescent Bariatric Surgery: A Nonrandomized Pilot Study.

Objectives: Evidence in adults suggests that improvements in cognitive performance may follow weight loss resulting from bariatric surgery, and baseline cognitive performance may be associated with weight loss following surgery. This has not been evaluated in adolescents. Method: Participants were 38 adolescents of age 14-21 years composed of three groups: (1) 12 adolescents with severe obesity who received vertical sleeve gastrectomy during the study (VSG); (2) 14 adolescents with severe obesity who were wait-listed for VSG (WL); and (3) 12 healthy weight controls (HC). Participants completed testing of visual memory, verbal memory, and executive functioning at baseline (T1), which occurred presurgery for the VSG group, and approximately 4 months after baseline (T2). Body mass index (BMI) was assessed at T1, T2, and additionally at 6 months following VSG for the adolescents who received surgery. Results: Although there was evidence of greater improvement for the VSG as compared with WL and HC groups in visual and verbal memory, group differences did not reach significance and effect sizes were small (η2 < 0.01). There was a significant positive association between indices of baseline executive functioning and excess BMI loss at 6 months postsurgery. Conclusions: This small pilot study showed no significant differences by group in cognitive performance post-VSG. There was a significant association of baseline cognitive performance with weight loss outcomes. Given the very preliminary nature of these results in a small sample, future research should examine these relationships in a larger sample and evaluate mechanisms of these associations (e.g., insulin resistance, sleep, physical activity).

BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development.

BACKGROUND: Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating. METHODS: We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial. CONCLUSIONS: Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population. CLINICAL TRIAL REGISTRATION NUMBER: NCT05268393.

Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial.

BACKGROUND: Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability. METHODS: Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up. RESULTS: Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility. CONCLUSION: Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.

Behavioral health outcomes and social determinants of health in children with diabetes and juvenile arthritis.

Objective: Children with chronic illnesses, including arthritis, are at increased risk for adverse psychosocial outcomes influenced by social determinants of health (SDOH). Comparing psychosocial outcomes in families affected by juvenile arthritis compared to other chronic illnesses may help identify areas in need of special attention vs areas that may be addressed through adopting other disease examples' care models. We examined child and parent behavioral health outcomes for families with juvenile arthritis compared to diabetes, accounting for SDOH. Methods: Secondary data analysis of the National Survey of Children's Health including 365 children (<18yrs) with arthritis and 571 children with diabetes. Psychosocial outcomes were depression, anxiety, ADHD, physical pain, behavioral problems, and treatment for mental health. School outcomes were school engagement, school absence, involvement in clubs/organization, and involvement in organized activities. Parent outcomes were family resilience, emotional support, coping with daily demands of raising a child, job change due to problems with childcare, and parent mental health. SDOH variables were food insecurity, food/cash assistance, unsafe neighborhood, detracting neighborhood elements, parent education, households earning <100% of the federal poverty line. Logistic regression analyses were utilized to examine variation in child and parent outcomes, variation in SDOH, and the role of SDOH. Results: Children with arthritis experienced significantly more physical pain, anxiety, depression, ADHD, and behavior problems compared to children with diabetes. Children with arthritis were more likely to see a mental health professional and get treatment for problems with emotions/behaviors. When considering SDOH, children with arthritis were still more likely to experience adverse psychosocial outcomes but were no longer more likely to get treatment. Children with arthritis had increased likelihood of school absence and were less involved in organized activities than children with diabetes. Parents of children with arthritis had poorer mental health than parents of children with diabetes. SDOH were more prevalent in children with arthritis than children with diabetes. Conclusions: Increased risk for adverse psychosocial outcomes in youth with arthritis compared to youth with diabetes indicates a need to mirror endocrinology models of care in rheumatology clinics. The role of SDOH highlights the need for regular SDOH screening in clinic.

Feasibility of a Home-Delivery Produce Prescription Program to Address Food Insecurity and Diet Quality in Adults and Children.

Produce prescription programs aim to improve food insecurity (FI) and nutrition but their effectiveness is unclear. We conducted a pilot study to demonstrate the feasibility and explore the potential impact of a family-based, home-delivery produce prescription and nutrition education program. We measured enrollment, satisfaction, participation, and retention as measure of feasibility. Adult participants answered pre-post self-report questionnaires assessing FI, child and adult fruit and vegetable intake, and culinary literacy and self-efficacy. To understand participants' lived experiences, qualitative interviews were conducted at the 6-month time point. Twenty-five families were enrolled. Feasibility measures indicate participants were generally satisfied with the program but there were important barriers to participation. Qualitative data revealed themes around reduced food hardship, healthy eating, budget flexibility, and family bonding. Fruit and vegetable consumption increased in a small subgroup of children, but post-intervention intake remained below recommended levels, particularly for vegetables. FI scores were not significantly different post-intervention, but qualitative findings indicated improved access and reliability of food. This is the first intervention of its kind to be evaluated for feasibility and our results suggest the intervention is well-received and supportive. However, further study, with a larger sample size, is needed to understand factors influencing participation and assess effectiveness.

Promoting glycemic control in young children with type I diabetes: Results from a pilot intervention for parents.

OBJECTIVE: Nutrition and physical activity are key components of daily diabetes care in young children with type I diabetes (T1D). Normative developmental behavioral challenges related to nutrition and physical activity complicate management of T1D. The current pilot study evaluated the feasibility, acceptability, and indications of behavior change of an intervention aimed at improving nutrition and physical activity in young children with T1D. METHOD: Thirty-6 parents of young children (ages 2-5 years, M = 4.2) with T1D from 2 clinics in the Washington, DC area were randomized to receive the type One Training (TOTs) program or Usual Care (UC). Assessments included recruitment and completion rates, participant acceptability, and outcomes including glycemic variability via continuous glucose monitoring, nutritional intake via remote food photography, physical activity via accelerometers, and parental report on behavior and psychosocial functioning. RESULTS: Despite recruitment challenges, the TOTs program was feasible to administer, with high program and assessment completion rates. Acceptability ratings were very high but differed by recruitment site. Participants randomized to TOTs had an increase in percent of time in target glycemic range and reduction in behavioral feeding problems between baseline and follow-up while those randomized to UC did not. Participants in UC demonstrated a decrease in in moderate to vigorous physical activity at follow-up. CONCLUSIONS: The TOTs program demonstrated preliminary feasibility and acceptability. Future research will examine components of treatment for evidence of efficacy and target the intervention to those most likely to benefit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth.

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

All in the Family: Child and Adolescent Weight Loss Surgery in the Context of Parental Weight Loss Surgery.

BACKGROUND: Bariatric surgery is the most effective current treatment option for patients with severe obesity. More children and adolescents are having surgery, many whose parents have also had surgery. The current study examines whether parental surgery status moderates the association between perceived social support, emotional eating, food addiction and weight loss following surgery, with those whose parents have had surgery evidencing a stronger relationship between the psychosocial factors and weight loss as compared to their peers. METHODS: Participants were 228 children and adolescents undergoing sleeve gastrectomy between 2014 and 2019 at one institution. Children and adolescents completed self-report measures of perceived family social support, emotional eating, and food addiction at their pre-surgical psychological evaluation. Change in body mass index (BMI) from pre-surgery to 3, 6, and 12 months post-surgery was assessed at follow-up clinic visits. Parents reported their surgical status as having had surgery or not. RESULTS: There were no differences in perceived family support, emotional eating, or food addiction symptoms between those whose parents had bariatric surgery and those whose parents did not. There were some moderating effects of parent surgery status on the relationship between social support, emotional eating/food addiction, and weight loss following surgery. Specifically, at 3 months post-surgery, higher change in BMI was associated with lower perceived family support only in those whose parents had not had surgery. More pre-surgical food addiction symptoms were associated with greater weight loss at 3 months for those whose parents had not had surgery, whereas this finding was true only for those whose parents had surgery at 12 months post-surgery. CONCLUSIONS: Children and adolescents whose parents have had bariatric surgery may have unique associations of psychosocial factors and weight loss. More research is needed to determine mechanisms of these relationships.

Implications of Perioperative Polypharmacy in Adolescents Undergoing Bariatric Surgery: a Single-Center Experience.

Adolescents seeking bariatric surgery may present with pre-existing psychiatric diagnoses for which they use chronic medications. To heighten awareness concerning perioperative polypharmacy in adolescents with extreme obesity, we conducted a retrospective review of patients undergoing laparoscopic sleeve gastrectomy between February 2010 and May 2017 at Children's National Health System (CNHS). A total of 167 adolescent patients had pre-existing psychiatric diagnoses which included depression (50%), anxiety (23%), ADHD (23%), and binge eating disorder (11%). Medications prescribed to treat these diagnoses included selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Additionally, all patients were given fentanyl, ondansetron, morphine, and acetaminophen perioperatively. Although no life threatening symptoms of drug-drug interactions (DDIs) were appreciated, the combined use of many different potent drugs in these patients warrants attention.

Preoperative exercise as a predictor of weight loss in adolescents and young adults following sleeve gastrectomy: a cohort study.

BACKGROUND: Preoperative exercise is associated with weight loss following bariatric surgery in adults, but this relationship in adolescents and young adults (AYA) is not well studied. OBJECTIVES: The present study examined AYA-reported preoperative exercise and demographic factors and their prediction of percent excess body mass index (BMI) loss at 6 and 12 months following sleeve gastrectomy. SETTING: The setting for recruitment and surgeries was in a children's hospital in the United States. METHODS: Participants were 173 AYA aged 12-21 years (mean age, 16.5 [SD, 2.0] yr; mean preoperative BMI, 50 [SD, 8.5] kg/m2). Demographic characteristics including age, sex, ethnicity, and preoperative BMI were extracted from the medical record. Preoperatively, adolescents self-reported on exercise using 5 items from the Center for Disease Control's Youth Risk Behavior Surveillance Survey. The study evaluated the association of self-reported preoperative exercise in total and obtained a threshold of higher exercise to weight loss at 6 and 12 months after surgery. RESULTS: More preoperative exercise was associated with greater weight loss at 12 months. Grouping participants by those who reported exercising at high levels (≥5 hr/wk) compared with those who reported <5 hr/wk, high levels of exercise predicted greater weight loss at 6 and marginally at 12 months postoperatively. Lower preoperative BMI was a significant predictor of weight loss in all analyses. CONCLUSIONS: Preoperative exercise may predict and contribute to weight loss in AYA and could be a target for pre- and postoperative intervention to improve outcomes. The importance of lower preoperative BMI for maximizing postoperative weight loss was also supported.

Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability.

BACKGROUND AND OBJECTIVES: Youth with cognitive impairment or developmental disability (CI/DD) face higher rates of obesity and secondary medical issues. Bariatric surgery may be a helpful tool for health improvement because it has been shown efficacious for adolescents. We aim to contribute to literature regarding bariatric surgery for adolescents with CI/DD and explore the association between cognitive functioning and weight loss outcomes. METHODS: Adolescents (N = 64) received a preoperative psychological evaluation, including cognitive assessment, and bariatric surgery at 1 weight loss program between 2010 and 2017. For these adolescents with measured cognitive performance, CI/DD was defined by an IQ <80 or previous diagnosis. In analyses, we compared adolescents with and without CI/DD. Structural equation modeling was used to assess the impact of cognitive functioning on weight loss 3 to 24 months postsurgery. RESULTS: There were no significant differences between adolescents with or without CI/DD in terms of preoperative BMI, age, and sex. Having CI/DD did not significantly impact weight loss or weight loss trajectory in the 2 years after surgery, although modeling revealed a trend toward individuals with CI/DD losing more weight over time. Similarly, intelligence scores did not predict weight loss after surgery. CONCLUSIONS: Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD. They could benefit from the surgery as much as those with typical development, and having CI/DD should not be used as a criterion to deny surgery. Continuing research with this population can be used to determine long-term outcomes in addition to defining best practices.

Analgesic Requirements in Adolescents Undergoing Bariatric Surgery-an Observational Study.

AIM: To examine the impact of preexisting psychiatric/psychological diagnoses on perioperative analgesic requirements in adolescents with morbid obesity undergoing bariatric surgery. METHODS: A retrospective cohort study of adolescents with morbid obesity undergoing bariatric surgery. Primary and secondary outcomes included perioperative analgesic intake and pain scores (Numerical Rating Scale (0-10) NRS) throughout the hospital stay. RESULTS: From our Bariatric Surgery Research Registry, we identified 17 adolescents with psychiatric/psychological diagnoses prior to undergoing bariatric surgery. Fifteen patients from the same registry and without such diagnosis undergoing bariatric surgery during the same time interval served as controls. In both groups, there was a predominance of female patients. During the perioperative period, in both groups, oral morphine equivalent and ketorolac and acetaminophen intake were similar. Notably, the perioperative median pain scores at the times examined were below 5 for all patients. The median pain scores in the PACU, day of surgery, and first postoperative day were similar. Conversely, on postoperative day 2, pain scores were higher in patients with diagnoses of psychiatric/psychological disorders (p = 0.004) compared to those without. CONCLUSION: In this cohort of morbidly obese adolescents undergoing bariatric surgery, patients with and without preexisting psychiatric/psychological diagnoses had similar analgesic requirements during the perioperative period. This finding appears contrary to those suggesting that preexisting depression and/or anxiety might be associated with increased analgesic requirements during the perioperative period.

Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling.

OBJECTIVE: To examine demographic and clinical characteristics, such as pediatric parenting stress and self-efficacy for diabetes care, of parents of children newly diagnosed with type 1 diabetes that are associated with parental anxiety and depression. METHODS: 102 parents reported on their levels of depression (CESD), state anxiety (STAI), pediatric parenting stress (PIP), and self-efficacy for diabetes care (SED) within 4 weeks of their child's diagnosis with type 1 diabetes. Data were analyzed using hierarchical multiple regression. RESULTS: Parents' scores in the clinical range for depression and anxiety were associated with increased frequency and difficulty of pediatric parenting stress, and there was a trend for depression to be related to lower self-efficacy for diabetes care. The association of female gender with anxiety and depression was partially mediated by more frequent pediatric parenting stress. CONCLUSION: Parents of children newly diagnosed with type 1 diabetes are at risk for experiencing anxiety and depression, related, in part, to their experiences of pediatric parenting stress. PRACTICE IMPLICATIONS: Providers and educators should be aware of the risk for depression and anxiety in parents and should work to decrease pediatric parenting stress, increase self-efficacy, and refer parents who are experiencing significant anxiety or depression following their child's diagnosis to a mental health specialist.

Psychiatric Diagnoses and Weight Loss Among Adolescents Receiving Sleeve Gastrectomy.

BACKGROUND AND OBJECTIVES: Severe obesity is associated with higher risk of psychiatric difficulties. Bariatric surgery is the most effective treatment of severe obesity. Few guidelines exist regarding the association of psychiatric diagnoses in adolescents and outcomes after surgery because of the lack of longitudinal research. Our objective is to evaluate the rates of psychiatric diagnoses in adolescents undergoing surgery compared with those not receiving surgery and the association of preoperative psychiatric diagnoses with postsurgical weight loss outcomes. METHODS: Adolescents (N = 222) referred for psychological evaluation at one institution for bariatric surgery (2009-2017) completed semistructured clinical interviews to assess the presence and number of psychiatric diagnoses. Comparison analyses were conducted between those who did not end up receiving surgery (N = 53) and those who did (N = 169). Using longitudinal modeling, we assessed the association of preoperative diagnoses with weight loss outcomes between 3 and 12 months after surgery. RESULTS: Seventy-one percent of adolescents qualified for a psychiatric disorder. There were no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. CONCLUSIONS: Psychiatric diagnoses are prevalent among adolescents with severe obesity. These diagnoses are not associated with weight loss outcomes. The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery.