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An Interprofessional Team Approach to Identifying Co-morbidities in Teens Eligible for Bariatric Surgery
An Interprofessional Team Approach to Identifying Co-morbidities in Teens Eligible for Bariatric Surgery
Submitted on 12 Feb 2018

Brittany M. Cozart MS3, Meari Taguchi MS4, Sadaf Aslam, MBBS, MS, Michel Murr, MD, John Paul Gonzalvo, DO, Amy Weiss, MD, MPH
USF Health Morsani College of Medicine
This poster was presented at USF Research Day 2018
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Poster Abstract
In the United States, 33.6% of youth are classified as being overweight, 18.4% as obese, and 13.0% as extremely obese(1). In pediatrics, having a BMI greater than or equal to the 95th percentile of their growth chart is considered obese (3). Due to an increase in severe childhood obesity and nonsurgical treatments not yielding significant weight-loss or resolving comorbidities, adolescents are now being considered for weight-loss surgeries (2). The TGH+USF Bariatric Center uses a multi-disciplinary team to help each patient achieve their weight-loss goals in the pursuit of wellness.

Adolescents who met the criteria of being ≥16 years, with a BMI ≥35 with co-morbidities, or BMI≥40, were first required to attend an adolescent bariatric information session, then met with the team monthly for 6 months before they could be considered for bariatric surgery. The visits focused on medical weight-loss, treatment of comorbidities, nutrition and exercise education, and psychological evaluation. Descriptive statistics were performed.

Forty-two adolescent patients were evaluated. Nineteen have completed the 6 visits needed for surgery and six of those nineteen have had surgery. Twenty-three patients have not finished their required 6 visits but have finished 1 to 5 visits. Four patients did not return after completing their first visit and one patient no showed their first visit. Four patients did not meet the inclusion criteria for the study due to having <1 visit or not having a BMI >35 with co-morbidities. There are forty-one patients total, thirty females (73.2%) and eleven males (26.8%), who have attended 1 to 6 appointments.

The following analysis is made on the thirty-eight adolescents who met the inclusion criteria, 10 males and 28 females. The ethnicities of the patients included Caucasian (34%), Hispanic/Latino (34%), African-American (21%), Asian and Other (10%). The mean initial age was 16.74 (S.D 1.29) and the mean initial BMI was 51.03 (S.D 10.95). All but six patients (15.8%), have attempted other weight-loss programs. Dieting history responses from patients showed that one used laxatives in the past and two used weight loss pills, and sixteen patients reported practicing binge eating. Patients presented with the following initial co-morbidities: vitamin D deficiency (55.3%), polycystic ovarian syndrome (39.3% of the 28 females), pre-hypertension (10.5%) hypertension (7.9%); dyslipidemia (26.3%), iron deficiency (15.8%), elevated ALT (7.9%), pre-diabetes (36.8%), diabetes (23.7%) and obstructive sleep apnea (34.2%). Initial psychological examination using Beck Depression Inventory showed that one patient had moderate depression (2.6%), three patients had minimal to mild depression (7.9%), but 57.9% reported being depressed or having a previous history of depression and 42% reported having anxiety. 

All the adolescents who received surgery got a gastric sleeve, liver biopsy, and had an intraoperative esophagogastroduodenoscopy. Five of the six had robotic assisted laparoscopic surgery while one had laparoscopic surgery. The male to female ratio in the surgical group was 1:5. Of the females who got the gastric sleeve, 4/5 got IUDs. Hiatal hernias were found in 5/6 patients and were repaired. Mean operative time was 156 minutes (SD 39.5) with estimated blood loss of 28.33 mL (SD 11.25) and mean fluids given 2183.33 mL (SD 545.6). Five of the six patients were discharged on post-operative day 2 with one being discharge on post-operative day 3. There were no reported complications for any of the six adolescents. 

Medical and psychological co-morbidities were high in this population. Currently the data suggests males have a lower interest in weight-loss surgery compared to females. The treatment of these co-morbidities is crucial in aiding these adolescents with achieving their goals and obtaining post operative success.

1. Paulus, F.G., Loes, de Vaan, L.E., Verdam, F. J., Bouvy, N. D., Ambergen, T. A., &van Heurn, L. W (2015). Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-analysis. Obesity Surgery, 2015; doi: 10.1007/s11695-015-1581
2. TH, I., MH, Z., TM, J., & al, et. (2014). Perioperative outcomes of adolescents undergoing bariatric surgery: The teen–longitudinal assessment of bariatric surgery (teen-labs) study. JAMA Pediatrics, 168(1), 47–53. Retrieved from
3. Defining Childhood Obesity. (2015, June 19). Retrieved July 29, 2016, from 
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