title: Bariatric surgery decision making challenges: the stability of teens' decisions and the treatment failure paradox.
abstract: OBJECTIVE
  Criteria for adolescent bariatric surgery include failure of ≥6 months of organized weight loss attempts. We wished to explore whether adolescents, initially wanting surgery, change their mind during a 6-month weight loss program and how many meet the treatment failure criterion.
  
  
  METHODS
  A retrospective chart review of adolescents enrolled in a weight loss program between 3/2007 and 2/2009.
  
  
  RESULTS
  Twenty-one (13 % of total patients) initially wanted bariatric surgery. Most were Medicaid enrollees (70 %), female (85 %), and white (60 %). The mean age was 15 years and mean BMI was 51 (range 36-71). Five did not meet BMI, comorbidity, or psychological criteria for surgery. Eight lost weight and therefore did not meet the treatment failure criterion. Of these, seven no longer wanted surgery. Eight did not lose weight and therefore met the treatment failure criterion; five of these decided against surgery due to difficulty in making recommended lifestyle changes.
  
  
  CONCLUSIONS
  Most patients initially wanting bariatric surgery changed their minds. The treatment failure criterion presented a paradox, because most patients who met the criterion exhibited difficulty in making the lifestyle changes. To aid provider/patient decisions about bariatric surgery, further work should explore the criteria for surgery and stability of adolescents' decisions regarding bariatric surgery.
authors.affiliation: Pediatric Comprehensive Weight Management Center, University of Michigan, Ann Arbor, MI 48109-5456, USA. swoolfor@med.umich.edu
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Woolford
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Sallinen
authors.forename: James D
authors.initials: JD
authors.lastname: Geiger
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008824:Michigan; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D000297:Psychology, Adolescent; D012189:Retrospective Studies; D017211:Treatment Failure; D014481:United States; D015431:Weight Loss