Weight Loss Surgery in Adolescents With Extreme Obesity

Study Overview
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Brief Summary
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The use of bariatric surgery in adolescents is controversial. On one side, bariatric surgery is the only effective treatment to achieve sustained weight loss in adults with extreme obesity. Comorbidities are reversed and mortality is reduced. In adolescents, bariatric surgery is equally effective; however, due to the paucity of long-term data, the long-term effects and risks are unknown. Thus, due to surgical risk and ethical implications, bariatric surgery is considered experimental in Germany. Nevertheless, case volumes are increasing. The aim of this study is to evaluate the benefits and risks of adolescent bariatric surgery in the context of a structured preparation and follow-up program. The study is a subproject of the study Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care (DRKS00004172). At 5 German university centers (Ulm, Datteln, Berlin, Essen, Leipzig), youth who undergo bariatric surgery and are participants in the overall project will be enrolled in a structured preparation and follow-up program. The program is designed to improve adherence and compliance and will result in comprehensive follow-up data. In addition to the data gathered in the overall project, subjects participating in subproject 3 will undergo assessments pertinent to bariatric surgery, as proposed in the American Teen-LABS study (http://www.cincinnatichildrens.org/ research/divisions/t/teen-labs/default/). Comparison will be made with BMI matched adolescents who participate in the overall project but do not undergo bariatric surgery. In November 2014 recruitment for the overall project was completed. However, patients interested in bariatric surgery will still be recruited until September 2016. There assessment will be the same as for patients recruited earlier. However, in an amendment in December 2014, the frequency of assessment via questionnaire was reduced from biannually to annually. In addition, a travel reimbursement of 30€ for each study visit was implemented.

Official Title
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Effectiveness and Safety of Weight Loss Surgery in Adolescents With Extreme Obesity Within a Structured Pre- and Post-surgery Treatment Program, Subproject 3

Conditions
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Obesity, Extreme Obesity

Intervention / Treatment
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* Procedure: bariatric surgery
* Other: conservative care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI ≥ 35 kg/m2 with severe comorbidity or BMI ≥ 40 kg/m2 with relevant comorbidity completed longitudinal growth stable social surroundings exhaustion of conservative treatment participation in the project Adolescents with extreme Obesity adequate compliance and adherence Exclusion Criteria: treatable causative condition unstable medical, psychosocial or psychiatric comorbidity alcohol or drug abuse pregnancy contraindication for bariatric surgery

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| bariatric surgery group<br>subjects who participate in the overall project and undergo bariatric surgery | Procedure: bariatric surgery<br>* The intervention takes place in the clinical care setting. The decision for surgery is made by a multidisciplinary team, according to the international guidelines and the recommendations of the German working group on obesity (AGA, www.a.g.a.de). The choice of procedure is made on an individual basis taking into consideration patient inherent factors as well as the recommendations of the operating center. Operations are conducted at certified bariatric centers according to the policies of the German working group on bariatric surgery (CAADIP), and in the context of a structured preparation and follow-up program. The program is offered by a multidisciplinary team (pediatrician, endocrinologist, surgeon, dietician, psychologist/psychiatrist, social worker) and comprises preparation for and education about the surgery and expected lifestyle changes, as well as a structured, multidisciplinary follow-up plan. Subjects sign a contract agreeing to adhere to the recommended follow-up schedule.<br>|
| conservative care group<br>subjects who participate in the overall project and do not undergo bariatric surgery | Other: conservative care<br>* Subjects will be seen by a trained study physician every 6 months. Stuctured health assessments will be conducted, and individual treatment recommendations will be made based on the patients motivation and ability(e.g. inpatient obesity rehab, exercise, dietary or behavioral intervention etc.)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| BMI change from baseline |  | 1 year postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| BMI |  | every 6 months for 9 years | 
| changes in somatic comorbidity | Will be assessed via standardized physical examination, laboratory and apparative tests, and standardized patient questionnaires. | every 12 months for 9 years | 
| changes in psychosocial comorbidity | Will be assessed via standardized patient questionnaires. | every 12 months for 9 years | 
| changes in psychiatric comorbidity | Will be assessed via standardized psychiatric evaluation and standardized and validated patient questionnaires. | every 12 months for 9 years | 
| peri- und postoperative complications | Will be assessed via physician questionnaires. | every 12 months for 9 years | 
| vitamin deficiencies | Will be assessed via patient questionnaire and laboratory studies. | every 6 months for 9 years | 
| adherence with postoperative recommendations on supplements, doctors visits and nutrition | Will be assessed via patient questionnaire. | every 12 months for 9 years | 
| hunger, food tolerance, gastrointestinal symptoms, dumping | Will be assessed via patient questionnaire. | every 12 months for 9 years | 
| eating behavior | Will be assessed via validated questionnaire (EDE-Q). | every 12 months for 9 years | 
| exercise | Will be assessed via validated questionnaire (IPAQ). | every 12 months for 9 years | 
| changes in quality of life: SF36 | Will be assessed via validated questionnaires (SF36). | every 12 months for 9 years | 
| changes in quality of life: IWQOL | Will be assessed via validated questionnaires (IWQOL). | every 12 months for 9 years | 
| schooling, vocation, psychosocial situation, functional impairments | Will be assessed via standardized patient questionnaire. | every 12 months for 9 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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psychosocial, healthcare, co-morbidities, extremely obese adolescents