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Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis

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Abstract

Background

Metabolic and bariatric surgery is an effective strategy to curb the natural history of obesity progression and improve psychosocial status in the short term for adolescents with severe obesity. The medium- and long-term psychosocial impact of bariatric surgery in this population is not established.

Methods

We searched MEDLINE (Ovid), EMBASE, Web of Science, PsycInfo, and the Cochrane Libraries through October 2017 for reports of weight loss surgery (roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding) on adolescents with severe obesity (age ≤ 21 years) having ≥ 6 months of follow-up. The primary outcome for inclusion in systematic review was use of a validated quality of life (QoL) or other psychosocial instrument at baseline and postoperatively. We used standardized mean difference (SMD) and random-effects modeling to provide summary estimates across different instruments.

Results

We reviewed 5155 studies, of which 20 studies met inclusion criteria for qualitative synthesis. There were 14 studies and 9 unique cohorts encompassing 573 patients which were eligible for meta-analysis regarding postoperative change in QoL. Across surgical procedures, there was significant improvement in QoL of 1.40 SMD (95% confidence interval 0.95 to 1.86; I2 = 89%; p < 0.001) at last follow-up (range 9–94 months). Trends in QoL improvement demonstrated the greatest improvement at 12 months; however, significant improvement was sustained at longest follow-up of 60+ months.

Conclusions

Weight loss surgery is associated with sustained improvement in QoL for adolescents with severe obesity across surgical procedures. Long-term data for psychosocial outcomes reflecting other mental health domains is lacking.

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Acknowledgments

We are thankful for and gratefully acknowledge the guidance of Marc P. Michalsky, MD, and Meg H. Zeller, PhD, in helping to define the criteria for our search strategy as well as with the interpretation and framing of our results.

Funding

This material is based upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

    Spencer W. Trooboff & Ryland S. Stucke

  2. VA Quality Scholars Program, Veterans Health Administration, White River Junction, VT, USA

    Spencer W. Trooboff

  3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA

    Spencer W. Trooboff, Natalie BV Riblet, Anupama S. Kulkarni, Rupreet Anand & Ariana Casey

  4. Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

    Marc A. Hofley

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  1. Spencer W. Trooboff
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Correspondence to Spencer W. Trooboff.

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Supplementary Appendix B

Funnel plot of effect size versus standard error for studies included in meta-analysis of change in quality of life at last follow-up (PNG 402 kb)

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Trooboff, S.W., Stucke, R.S., Riblet, N.B. et al. Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis. OBES SURG 29, 3653–3664 (2019). https://doi.org/10.1007/s11695-019-04048-3

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