title: Inpatient weight loss as a precursor to bariatric surgery for adolescents with extreme obesity: optimizing bariatric surgery.
abstract: BACKGROUND
  As the obesity epidemic takes its toll on patients stricken with the disease and our health care system, debate continues regarding the use of weight loss surgery and its long-term consequences, especially for adolescents. One subset of patients regarding whom there is increased controversy is adolescents with extreme obesity (BMI > 60 kg/m(2)) because the risk of complications in this weight category is higher than for others undergoing bariatric surgery. Several strategies have been suggested for this patient group, including staged operations, combined operations, intragastric balloon use, and endoluminal sleeve placement. However, the device options are often not available to adolescents, and there are no data regarding staged or combined procedures in this age group.
  
  
  METHODS
  All adolescents with BMI >60 kg/m(2) referred to our program were evaluated for inpatient medical weight loss prior to laparoscopic sleeve gastrectomy. The program utilizes a multidisciplinary approach with a protein-sparing modified fast diet, exercise, and behavioral modification.
  
  
  RESULTS
  Three patients completed the program, and each achieved significant preoperative weight loss through the inpatient program and successfully underwent bariatric surgery.
  
  
  CONCLUSIONS
  Presurgical weight loss via an inpatient program for adolescents with a BMI >60 kg/m(2) results in total weight loss comparable to a primary surgical procedure alone, with the benefit of decreasing the perioperative risk.
authors.affiliation: The George Washington University School of Medicine, Washington, DC, USA. ekoeck@cnmc.org
authors.forename: Emily
authors.initials: E
authors.lastname: Koeck
authors.forename: Katherine
authors.initials: K
authors.lastname: Davenport
authors.forename: Leah C
authors.initials: LC
authors.lastname: Barefoot
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
authors.forename: Daniel
authors.initials: D
authors.lastname: Davidow
authors.forename: Evan P
authors.initials: EP
authors.lastname: Nadler
mesh_terms: D000293:Adolescent; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D063766:Pediatric Obesity / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D061217:Weight Reduction Programs / Q000379:methods
keywords: bariatric surgeries; morbid obesity; weight reduction