title: Psychological contributors to noncompletion of an adolescent preoperative bariatric surgery program.
abstract: BACKGROUND
  Noncompletion of preoperative bariatric programs is a significant problem among adolescents. Adult studies suggest that psychological factors contribute to noncompletion of preoperative bariatric programs.
  
  
  OBJECTIVE
  The aim of this study was to determine the association between adolescent psychological functioning and completion of the preoperative phase of a bariatric program.
  
  
  METHODS
  The study was conducted at a tertiary care children's hospital affiliated with a university medical center.
  
  
  METHODS
  Seventy-four adolescents and their parents completed an assessment measure of psychological functioning with the Behavior Assessment System for Children, Second Edition. We compared these scores between adolescents who completed the preoperative phase of the bariatric program and proceeded to surgery (completers) to those who did not (noncompleters) using multivariate analysis of covariance and logistic regression analyses, adjusting for demographic characteristics and baseline body mass index.
  
  
  RESULTS
  The mean age was 16.0 (1.1) years, most were female (79.8%), and the group was diverse (48.6%, Caucasian; 33.8%, black; 17.6%, other, including Hispanic, Asian, and biracial). Average body mass index was 50.5 (7.6) kg/m2. Forty-two percent of participants were noncompleters. Noncompleters were reported by parents to have more clinically significant externalizing and internalizing behaviors and fewer adaptive behaviors. Noncompleters self-reported more clinically significant internalizing symptoms, emotional problems, and poor personal adjustment.
  
  
  CONCLUSIONS
  Adolescents who did not complete the preoperative phase of a bariatric surgery program had more clinically significant psychological symptoms across multiple domains compared with those who successfully proceeded to bariatric surgery. Early identification and treatment of psychological symptoms may be important in helping adolescents successfully proceed to surgery.
authors.affiliation: Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: megan.cohen@nemours.org.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Cohen
authors.affiliation: Department of Developmental Pediatrics, Eastern Maine Medical Center, Bangor, Maine.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Curran
authors.affiliation: Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Thao-Ly T
authors.initials: TT
authors.lastname: Phan
authors.affiliation: Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kirk
authors.initials: K
authors.lastname: Reichard
authors.affiliation: Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: George A
authors.initials: GA
authors.lastname: Datto
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000886:Anthropometry; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015391:Gastroplasty / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000523:psychology*; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology*; D063766:Pediatric Obesity / Q000208:ethnology / Q000523:psychology*; D011300:Preoperative Care / Q000523:psychology; D061217:Weight Reduction Programs
keywords: Adolescence; Attrition; Pediatric obesity; Weight loss Surgery