Elsevier

The Journal of Pediatrics

Volume 156, Issue 1, January 2010, Pages 103-108.e1
The Journal of Pediatrics

Original Article
Baseline BMI is a Strong Predictor of Nadir BMI after Adolescent Gastric Bypass

https://doi.org/10.1016/j.jpeds.2009.07.028Get rights and content

Objective

Surgical treatment of extreme obesity may be appropriate for some adolescents. We hypothesized that surgical weight loss outcomes may differ by preoperative level of extreme obesity (body mass index [BMI] ≥99th percentile).

Study design

A longitudinal assessment of clinical characteristics from 61 adolescents who underwent laparoscopic Roux-en-Y gastric bypass at a single pediatric center from 2002 until 2007 was performed. Patients were categorized into 1 of 3 preoperative BMI groups: group 1, BMI = 40.0 to 54.9 (n = 23); group 2, BMI = 55.0 to 64.9 (n = 21); group 3, BMI = 65.0 to 95.0 (n = 17). Changes in BMI and cardiovascular risk factors between baseline and year 1 were evaluated using repeated-measures mixed linear modeling.

Results

BMI in the overall cohort at baseline (60.2 ± 11 kg/m2) decreased by 37.4% at 1 year after surgery (P < .001). Percent BMI change varied little by preoperative BMI groups (−37.2%, −36.8%, and −37.7% for groups 1, 2, and 3 respectively; P = .8762). The rate of change in absolute BMI units significantly varied by preoperative BMI class (group × time interaction, P < .0001), with 1-year nadir BMI values for groups 1, 2, and 3 falling to 31 ± 4 kg/m2, 38 ± 5 kg/m2, and 47 ± 9 kg/m2, respectively. One year after surgery, only 17% of patients achieved a nonobese BMI (<30 kg/m2). Significant improvements in systolic and diastolic blood pressure (P < .0001), fasting insulin (P < .0001), total cholesterol (P = .0007), and triglyceride levels (P < .0001) were seen after surgery irrespective of baseline BMI class. Mean albumin levels remained normal despite significant caloric restriction and weight loss.

Conclusions

Laparoscopic gastric bypass resulted in improvement or reversal of cardiovascular risk factors and resulted in a decrease in BMI of approximately 37% in all patients, regardless of starting BMI, 1 year after surgery. The timing of surgery for adolescent extreme obesity is an important consideration, because “late” referral for bariatric surgery at the highest of BMI values may preclude reversal of obesity.

Section snippets

Methods

The Follow-up of Adolescent Bariatric Surgery (FABS) study is a single-center, longitudinal outcome study of adolescents and young adults (age ≤21 years) seeking obesity treatment at Cincinnati Children's Hospital Medical Center (CCHMC). Patients enrolled in FABS who underwent laparoscopic RYGB surgery between August 2002 and January 2007 at CCHMC were included in this analysis. The operation was performed in a similar fashion in all patients with a side-to-side jejunojejunostomy and an

Results

Over a 5-year period (2002 to 2007), 61 consecutive adolescents underwent laparoscopic RYGB surgery. The mean BMI at baseline for these patients was 60.2 kg/m2, ranging from 41.4 to 95.5 kg/m2. Nearly 70% of this cohort was female, with 83.6% self-identified as white race (Table I). The mean age at surgery was 17.2 years (range, 13 to 23 years). The average time from initial baseline consultation to surgery was 5.0 months. The mean Roux length was 119.2 cm. Preoperative BMI groups were similar

Discussion

Extreme obesity is now recognized as major pediatric health problem. Recent estimates indicate that 4% of children ages 5 to 17 years in the United States are extremely obese.11 Nearly two thirds of such children have 2 or more cardiovascular risk factors, and a substantial proportion have significant metabolic comorbidities typically seen in adults, including obstructive sleep apnea, diabetes mellitus, nonalcoholic steatohepatitis, and significant hypertension and left ventricular hypertrophy.

References (33)

  • T.H. Inge et al.

    Teen-Longitudinal Assessment of Bariatric Surgery: methodological features of the first prospective multicenter study of adolescent bariatric surgery

    J Pediatr Surg

    (2007)
  • C.L. Ogden et al.

    Prevalence of overweight and obesity in the United States, 1999-2004

    JAMA

    (2006)
  • R. Sturm

    Increases in clinically severe obesity in the United States, 1986-2000

    Arch Intern Med

    (2003)
  • R. Weiss et al.

    Obesity and the metabolic syndrome in children and adolescents

    N Engl J Med

    (2004)
  • J.M. Silvestri et al.

    Polysomnography in obese children with a history of sleep-associated breathing disorders

    Pediatr Pulmonol

    (1993)
  • R.T. Loder et al.

    The epidemiology of bilateral slipped capital femoral epiphysis: a study of children in Michigan

    J Bone Joint Surg Am

    (1993)
  • Cited by (133)

    • Obesity, Metabolic Syndrome and Disorders of Energy Balance

      2020, Sperling Pediatric Endocrinology: Expert Consult - Online and Print
    • Bariatric Surgery and Adolescent Type 2 Diabetes

      2019, Pediatric Type II Diabetes
    View all citing articles on Scopus

    This study was funded in part by investigator-initiated grant support from Ethicon Endosurgical, Blue Ash, Ohio. The authors declare no conflicts of interest.

    View full text