title: [Bariatric surgery in obese adolescents: When and how should the transition from pediatric to adult medical management be made?].
abstract: BACKGROUND
  In young obese patients, the transition from adolescence to adulthood, i.e., the transition from the pediatric to the adult medical team, is a new issue. In particular, it is important to define when and how this transition should be made in the setting of bariatric surgery.
  
  
  METHODS
  Fourteen young obese patients (under the age of 20), who underwent bariatric surgery, were included in the study (nine cases of Roux-en-Y gastric by-pass, three sleeve gastrectomy, one gastric banding). After surgery, the patients were followed in both the pediatric and adult departments (protocol 1) or only in the pediatric department during the 1st year and then in the adult department afterwards (protocol 2). Anthropometric and metabolic data, before and after surgery, and compliance monitoring were analyzed using a retrospective design. Twelve patients completed a questionnaire assessing how they experienced the transition.
  
  
  RESULTS
  Before surgery, mean age±SD was 16.3±1.8 years old and mean body mass index (BMI) 55.0±8.6kg/m(2). At 1 year after surgery, mean weight loss was -32.1±8.2% of initial body weight. Adherence to vitamin supplementation was judged to be adequate (vitamins were not taken less than once a week) for only 57.5% patients. Mean follow-up was 34.8±25.1 months [95% CI, 9.5-78.4]. None of the patients was lost to follow-up. Compliance was significantly better for patients following protocol 2. Adolescents reported being satisfied with meetings and newsletters about surgery, specific to this age group (91.7%). They also reported that information on the adult department was sufficient and 91.7% of them expressed satisfaction on the first outpatient visit in the adult department. However, all patients spontaneously reported having difficulties identifying members of the different teams: nutritionist pediatrician, nutritionist, and adult surgeon.
  
  
  CONCLUSIONS
  These preliminary data suggest that, in obese adolescents, it is important to differentiate the transition period and the time and preparation for bariatric surgery. A prospective follow-up with a larger number of subjects and recommendations are needed to better define and improve the specific clinical management of obese adolescents transitioning to adulthood.
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Paepegaey
authors.affiliation: Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Dubern
authors.affiliation: Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Karsenty
authors.affiliation: Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Chantereau
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Aron-Wisnewsky
authors.affiliation: Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Oderda
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Hadoux
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Robert-Gary
authors.affiliation: Service de chirurgie digestive et métabolique, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92104 Boulogne, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Bouillot
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Oppert
authors.affiliation: Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Tounian
authors.affiliation: Institut de cardiométabolisme et de nutrition (ICAN), service de nutrition, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75005 Paris, France. Electronic address: christine.poitou-bernert@psl.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Poitou
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D063766:Pediatric Obesity / Q000601:surgery*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D055815:Young Adult