Person:

Misra, Madhusmita

Background: Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB vs. SG in this age-group are scarce. This study aims to compare short-term (1–6 months) and longer-term (7–18 months) body mass index (BMI) and biochemical outcomes following RYGB and SG in adolescents/young adults. Methods: A retrospective study using data extracted from medical records of patients 16–21 years who underwent RYGB or SG between 2012 and 2014 at a tertiary care academic medical center. Results: Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race, or BMI. BMI reductions were significant at 1–6 months and 7–18 months within groups (p < 0.0001), but did not differ by surgery type (p = 0.65 and 0.09, for 1–6 months and 7–18 months, respectively). Over 7–18 months, within-group improvement in low-density lipoprotein (LDL) (−24 ± 6 in RYGB, p = 0.003, vs. −7 ± 9 mg/dl in SG, p = 0.50) and non-high-density lipoprotein (non-HDL) cholesterol (−23 ± 8 in RYGB, p = 0.02, vs. −12 ± 7 in SG, p = 0.18) appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH), patients with Stage II–III NASH had greater reductions in alanine aminotransferase levels vs. those with Stage 0–I NASH (−45 ± 18 vs. −9 ± 3, p = 0.01) after 7–18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. Conclusion: RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.

Syngelaki et al. (Feb. 4 issue)1 describe the efficacy of metformin in reducing gestational weight gain in women with a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of more than 35. Although their study does not show a reduction in the neonatal birth weight, their results underscore the ability of metformin to reduce gestational weight gain in women with moderate-to-severe obesity without diabetes. One question is whether the exclusion of patients who were started on insulin after the oral glucose-tolerance test would alter the results of the study. Another question is whether a larger sample size would result in significant results for the proportion of women with miscarriages, premature births, or live births across groups. Studies have shown that metformin is safe during pregnancy, with efficacy in treating gestational diabetes mellitus and the polycystic ovary syndrome, and that the drug has no effect on the growth of several cancers.2,3 It would be interesting if the authors of this and concurrent studies were to consider whether the use of metformin during pregnancy in women who are obese (BMI, >30) and those who are not obese (BMI, ≤30) would decrease weight retention after birth.1,4 Postpartum weight retention contributes to obesity in all weight classes, and the use of metformin would be an attractive option to reduce this risk.5

This was a retrospective, observational chart review conducted on a convenience sample of 537 outpatients, aged 16–60 years, referred to an Italian Dietetic and Nutrition University Center. The study aimed to look at the association between a history of child- hood obesity and dieting behaviors with development of eating disorders (EDs) at a later age. Subjects with a history of EDs (n = 118), assessed using both self-report and health records, were compared with those with no EDs (n = 419), who were attending the clinic mainly for primary prevention of metabolic and cardiovascular risk. Logistic regression analysis was performed to assess the association of childhood-onset obesity with develop- ment of an ED at a later age. Childhood-onset obesity, gender, maternal history of eating disorders, and dieting were associated with a positive history of EDs at a later age (p < .05). It is important to raise professional awareness of early symptoms of EDs in children with a history of obesity and treat them accordingly.