Original article: integrated health
Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery

https://doi.org/10.1016/j.soard.2019.03.001Get rights and content

Highlights

  • Surgical and nonsurgical females were similar in many sexual health domains.

  • Surgical reported greater increase in lifetime HIV-Risk behaviors over time.

  • Surgical had higher number of pregnancies/live births and teen motherhood.

  • Uniquely adolescent post-operative care guidelines are indicated.

Abstract

Background

Adolescents females with severe obesity are less likely to be sexually active, but those who are sexually active engage in risky sexual behaviors.

Objectives

To examine patterns and predictors of sexual risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did or did not undergo bariatric surgery across 4 years.

Setting

Five academic medical centers.

Methods

Using a prospective observational controlled design, female adolescents undergoing bariatric surgery (n = 111; Mage = 16.95 ± 1.44 yr; body mass index: MBMI = 50.99 ± 8.42; 63.1% white) and nonsurgical comparators (n = 68; Mage = 16.18 ± 1.36 yr; MBMI = 46.47 ± 5.83; 55.9% white) completed the Sexual Activities and Attitudes Questionnaire at presurgery/baseline and 24- and 48-month follow-up, with 83 surgical females (MBMI = 39.27 ± 10.08) and 49 nonsurgical females (MBMI = 48.56 ± 9.84) participating at 48 months.

Results

Most experienced sexual debut during the 4-year study period, with a greater increase in behaviors conferring risk for sexually transmitted infections (STIs) for surgical females (P = .03). Half (50% surgical, 44.2% nonsurgical, P = .48) reported partner condom use at last sexual intercourse. The proportion of participants who had ever contracted an STI was similar (18.7% surgical, 14.3% nonsurgical). Surgical patients were more likely to report a pregnancy (25.3% surgical, 8.2% nonsurgical, P = .02) and live birth (16 births in 15 surgical, 1 nonsurgical), with 50% of offspring in the surgical cohort born to teen mothers (age ≤19 yr).

Conclusions

Bariatric care guidelines and practices for adolescent females must emphasize the risks and consequences of teen or unintended pregnancies, sexual decision-making, dual protection, and STI prevention strategies to optimize health and well-being for the long term.

Section snippets

Overview of study design

Participants in the Teen Longitudinal Assessment of Bariatric Surgery consortium (Teen-LABS) (n = 242, age 13–19 yr), a multisite prospective observational safety and efficacy study [29], were invited, if eligible, to participate in a parallel series of independently funded, ancillary studies tracking the psychosocial benefits and risks of bariatric surgery from presurgery and across the first 4 postoperative years. These ancillary studies were enhanced by the inclusion of a comparative

Sample characteristics

Participants were predominantly white (surgical: 63% [n = 70]; nonsurgical: 56% [n = 38]; P = .34), with surgical females significantly older (surgical: 16.95 ± 1.44 yr; nonsurgical: 16.18 ± 1.36 yr; P =.001). The surgical cohort presented with a higher BMI than the nonsurgical cohort at baseline (surgical: 50.99 ± 8.42 kg/m2; nonsurgical: 46.47 ± 5.83 kg/m2; P < .001) and underwent a primary surgical procedure: 66% (n = 73) Roux-en-Y gastric bypass (RYGB), 32% (n = 35) sleeve gastrectomy (SG),

Discussion

The majority of females experienced sexual debut during the 4-year study window (postoperatively for surgical females) at an age consistent with age-normative trends (≈17 yr) and with an increase in past-year sexual risk behaviors over time [1], [2]. However, when considering a broader set of lifetime health risk behaviors known to confer greater risk for acquiring HIV or any STI (i.e., lifetime HIV-Risk score), surgical females demonstrated a significant surge in risk behavior engagement

Conclusions

Reduction of teen pregnancies and child-bearing, unintended pregnancies, and STI/HIV-Risks are public health priorities for all adolescents and young adults [52]. Thus, while many outcomes reported herein fell within age-normative ranges, their impact should not be interpreted as benign. Bariatric care for adolescent females must include ongoing education on dual protection strategies, the impact of substance use on sexual decision-making, STI/HIV prevention, and risks and consequences of teen

Disclosures

Thomas H. Inge has served as a consultant for Zafgen Corporation, Biomedical Insights, and L&E Research, and received honoraria from Standard Bariatrics, UpToDate, and Independent Medical Expert Consulting Services, all unrelated to this project. Anita P. Courcoulas has received research grants from Allurion Inc. David B. Sarwer has served as consultant for BARONova, Merz, and NovoNordisk.

Conflict of Interest

All authors have indicated they have no relationships relevant to this article to disclose.

Acknowledgements

The authors would like to acknowledge the contributions of additional TeenView Study Group Co-Investigators and staff. Cincinnati Children’s Hospital Medical Center: Faye Doland, BS; Ashley Morgenthal, BS; Taylor Howarth, BS; Sara Comstock, MA; Shelley Kirk, PhD; Michael Helmrath, MD, PhD. Texas Children’s Hospital: Margaret Callie Lee, MPH; David Allen, BS; Beth Garland, PhD; Gia Washington, PhD; Carmen Mikhail, PhD; Mary L. Brandt, MD. University of Pittsburgh Medical Center: Ronette Blake,

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