Adolescence and the transition to young adulthood is a developmental period distinguished by the emergence of mental health disorders and high-risk behaviors as significant public health concerns. Some individuals navigate these periods relatively unscathed, while others are launched on trajectories of varying health, psychosocial risk and competence. As weight loss surgery (WLS) emerges as a viable treatment for adolescents with severe obesity (BMI>40 kg/m2), it is imperative to identify the unique needs of the adolescent WLS patient across the post-operative course as they pass through these critical transitions. To date, WLS clinical care models are reliant on the adult experience. As such, critical targets and timing of prevention/ intervention efforts to optimize outcomes for the adolescent and as they mature remain largely undefined. In cooperation with the NIDDK's Teen-Longitudinal Assessment of Bariatric Surgery consortium (Teen-LABS;UM1 DK072493, PI: Inge), the PI's ancillary TeenView (R01DK080020;PI: Zeller) is the first prospective, controlled, observational study examining age-salient psychosocial health and risk associated with adolescent severe obesity and WLS outcomes in the short-term (6, 12, and 24-months). Preliminary data reveal post- operative improvements in weight and quality of life that are impressive, although for some patients begin to diminish by 24-months and into the mid-term (48-months). While a minority of adolescents present pre- surgically with clinical range psychopathology and/or a history of child adversities, the presence of these pre- surgical factors place patients (as they would any adolescent) on a trajectory of greater psychosocial risk, as well as variable weight loss outcomes in the short-term. Adolescent WLS patients also progress quickly from low rates of high-risk behaviors to more "normative" or even "inordinate" levels by 24-months, with initial evidence of links between substance use and weight change. The concern is heightened for the adolescent WLS patient given the adult WLS literature links post-operative psychopathology and weight loss outcomes, the emergence alcohol abuse/dependence, and increased risk of death by suicide. The proposed ancillary study "VIEWpoint", a continuation (renewal) application to TeenView, will extend the initial view of early post- operative outcomes to young adulthood and at the 6-year postoperative time-point, when durability of weight loss has further differentiated, yet psychosocial health and risk is entirely unknown. VIEWpoint aims are enhanced by (1) the TeenView foundation of relevant earlier adolescent psychosocial factors/contexts that may help explain the pathway from surgery to young adult psychosocial outcomes, and (2) an established TeenView non-operative, demographically similar, severely obese comparison group followed in parallel since adolescence. This rigorous and novel science will capitalize on the considerable investment in existing cohorts to further elucidate key contributors to optimal versus suboptimal WLS outcomes, information that is both timely and critically needed to inform age-salient patient care.

Public Health Relevance

Obesity, mental health, the engagement in HIV/sexual-risk behaviors, alcohol/tobacco/drug use, as well as suicidal behaviors are significant public health priorities for adolescents and young adults. Bariatric or weight loss surgery (WLS) has become a viable treatment option for adolescents whose obesity has progressed to extreme levels (BMI>40 kg/m2). It is thus imperative to identify the unique needs of the adolescent WLS patient across the post-operative course as they pass through these critical developmental transitions, as durability of weight loss is likely to be challenged, yet psychosocial health and risk is entirey unknown. Successful completion of the proposed study will reveal the trajectories of weight, psychopathology, high-risk behaviors, competence, and their associations following WLS, while also identifying key protective factors or emerging risks for the adolescent WLS patient as a young adult. As such, critical targets and timing of prevention/ intervention efforts will be identified to optimize outcomes for the adolescent patient as they mature. Hence, findings from the proposed study hold promise for a substantial and long-term impact and will define clinical practice guidelines for this specific age group and vulnerable population.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
2R01DK080020-06
Application #
8694241
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (J4))
Program Officer
Horlick, Mary
Project Start
2008-03-01
Project End
2019-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
6
Fiscal Year
2014
Total Cost
$405,135
Indirect Cost
$144,624
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229
Ratcliff, Megan B; Zeller, Meg H; Inge, Thomas H et al. (2014) Feasibility of ecological momentary assessment to characterize adolescent postoperative diet and activity patterns after weight loss surgery. Surg Obes Relat Dis 10:705-10
Zeller, Meg H (2013) Adolescent bariatric surgery: "you may ask yourself: how did I get here?". J Pediatr Psychol 38:117-25
Zeller, Meg H; Reiter-Purtill, Jennifer; Jenkins, Todd M et al. (2013) Adolescent suicidal behavior across the excess weight status spectrum. Obesity (Silver Spring) 21:1039-45
Ratcliff, Megan Benoit; Jenkins, Todd M; Reiter-Purtill, Jennifer et al. (2011) Risk-taking behaviors of adolescents with extreme obesity: normative or not? Pediatrics 127:827-34