title: Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS).
abstract: BACKGROUND
  The prevalence of obesity among adolescents has increased and we lack effective treatments.
  
  
  OBJECTIVE
  To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care.
  
  
  METHODS
  Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m(-2) undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care.
  
  
  METHODS
  Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group.
  
  
  RESULTS
  Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5 ± 6.1 (mean ± s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l(-1)) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients.
  
  
  CONCLUSIONS
  Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.
authors.affiliation: Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Medicine, Clinical Physiology and Paediatrics (Queen Silvia Children's Hospital), Gothenburg, Sweden. torsten.olbers@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Olbers
authors.forename: E
authors.initials: E
authors.lastname: Gronowitz
authors.forename: M
authors.initials: M
authors.lastname: Werling
authors.forename: S
authors.initials: S
authors.lastname: Mårlid
authors.forename: C-E
authors.initials: CE
authors.lastname: Flodmark
authors.forename: M
authors.initials: M
authors.lastname: Peltonen
authors.forename: G
authors.initials: G
authors.lastname: Göthberg
authors.forename: J
authors.initials: J
authors.lastname: Karlsson
authors.forename: K
authors.initials: K
authors.lastname: Ekbom
authors.forename: L V
authors.initials: LV
authors.lastname: Sjöström
authors.forename: J
authors.initials: J
authors.lastname: Dahlgren
authors.forename: H
authors.initials: H
authors.lastname: Lönroth
authors.forename: P
authors.initials: P
authors.lastname: Friberg
authors.forename: C
authors.initials: C
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods* / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D015431:Weight Loss