Prevalence of obesity among children and/or grandchildren of adult bariatric surgery patients.

BACKGROUND: Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children and grandchildren (< or =12 years of age) of adult bariatric surgery patients. METHODS: Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May 2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected. The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined as BMI percentile > or =95. Statistical significance was set at p < 0.05. RESULTS: One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m(2)). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile > or =95. Only 29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027). CONCLUSIONS: This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese children, interventions aimed at all family members merit consideration.

Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients.

BACKGROUND: Venous thromboembolism (VTE), manifest as deep venous thrombosis (DVT) or pulmonary embolus, remains an important complication in bariatric operation patients. Our purpose was to determine the incidence of VTE in a consecutive series of patients undergoing Roux-en-Y gastric bypass (RYGB) to guide appropriate therapy. METHODS: We prospectively examined a consecutive series of RYGB patients with bilateral lower-extremity venous duplex scan (DS) preoperatively, on postoperative day (POD)#2, and approximately POD#14. Preoperative clinical information including history of VTE, intraoperative data, postoperative course, and complications were recorded. Heparin 5,000 U subcutaneously was administered before the operation and every 12 hours throughout hospitalization along with sequential compression devices. Ambulation was instituted on POD#1. Temporary caval filters were placed in patients with a history of VTE. RESULTS: A total of 106 patients were examined. Body mass index was 51 +/- 8 kg/m2 (range, 40-73 kg/m2). Laparoscopic RYGB was performed in 75%. Hospital length of stay was 2.5 +/- 0.6 days. One hundred patients had no history of VTE; none had a positive DS preoperatively or on POD#2. One patient had a positive POD#14 DS and a second patient had a superficial thrombophlebitis, but a negative DS for DVT (both patients were symptomatic). Six patients had a prior history of VTE; all underwent preoperative placement of a temporary caval filter. Of these 6 patients, 1 developed a new postoperative DVT and another patient had thrombus on the caval filter with a negative lower-extremity DS. CONCLUSIONS: Occult DVT was not observed preoperatively in RYGB patients, suggesting that routine preoperative DS is not necessary in the absence of VTE history. Prophylaxis of heparin and sequential compression devices appears satisfactory in preventing DVT with only a 1% incidence in patients with no prior history of VTE. Two of the 6 patients with prior history of VTE showed evidence of thrombus postoperatively. Although a small number of patients, this finding suggests that a caval filter should be placed preoperatively in RYGB patients with a history of VTE.