S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study.

BACKGROUND: Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education. PURPOSE: To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes. METHODS: This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care. RESULTS: A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results. CONCLUSION: Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.

Recent trends of bariatric surgery in adolescent population in the state of New York.

BACKGROUND: In the United States the percentage of adolescents with obesity has reached an alarming level of 21%. Bariatric surgery has emerged as a successful intervention in the weight loss for adolescents. OBJECTIVE: To compare bariatric procedures performed in adolescent and adult populations. SETTING: University Hospital, United States. METHODS: Using the Statewide Planning and Research Cooperative System (SPARCS) database, records from the adolescent (age 12-21years) and adult populations undergoing bariatric surgery during 2005-2014 were examined. Patients' demographics, surgery type (Roux-en-Y gastric bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), length of stay (LOS), complications and comorbidities were analyzed. RESULTS: The annual adolescent bariatric cases increased from 150 in 2005 to 406 in 2014. In the adolescent population, increasing utilization trends were noted in the Hispanic population (RR=1.08, p-value<0.0001), use of Public (Medicaid or Medicare) insurance (RR=1.10, p-value=0.0003) and SG procedures (RR= 1.56, p-value <0.0001). Decreasing trends were noted in the Caucasian population (RR=0.95, p-value<0.0001), RYGB (RR=0.92, p-value<0.0001) and LAGB (RR= 0.84, p-value=0.0001). Adolescents undergoing bariatric surgery had fewer comorbidities (55.4% vs 81.1%, p-value<0.0001), experienced fewer complications (3.3% vs 4.9%, p-value<0.0001) and 30-day readmissions (3.8% vs 5.0%, p-value=0.0029). Length of stay was also found to be significantly shorter for the adolescent population (1.73 vs 2.00 days, p-value<0.0001). After adjusting for other confounding factors, adolescent patients still had significantly lower complication risk (p-value=0.01) and shorter length of stay (p-value=0.0005) than adults. CONCLUSION: Bariatric surgery procedure rates have increased in the adolescent population with increasing trend of using LSG. The data from our study supports that bariatric surgery is safe in adolescents with significantly lower complication risk and shorter length of stay as compared to the adult population.