G98 Multidisciplinary Assessment For Bariatric Surgery in Adolescents: A Pilot Project from a National Referral Service
Introduction Obesity has medical, social, psychological, familial and dietary underpinnings. We report the results of multidisciplinary assessments in adolescent bariatric surgery patients in the UK.
Aim 1. Multidisciplinary assessment of patients prior to bariatric surgery. 2. Compare outcomes from bariatric surgery to conventional treatment in the obesity clinic.
Methods 2F, 2M, mean age 14 yrs (12–18yrs) were selected for bariatric surgery. One boy with Oestegenesis Imperfecta (OI) had decrease mobility secondary to excess weight. Mean BMI 45kg/m2 (38–52 kg/m2). They were jointly assessed by a paediatrician and paediatric surgeon. Investigations completed: Full blood count, electrolytes, Vitamin D, liver ultrasound, fasting insulin and glucose. Secondary assessment by dietetics and child psychiatry looked at as binge patterns, night eating, comorbid psychopathology and family functioning. Quality of life score (Impact on weight on Quality-Kids IWQOL) and Becks Anxiety inventory (BAI) were performed. Operations were performed by a paediatric surgeon and experienced adult bariatric surgeon. Three had lap bands fitted, the boy with OI underwent a sleeve gastrectomy. Pre and post surgery data were collected.
Results All surgical patients lost weight over 3 months. Mean loss -10kg/m2 (5–17 kg/m2). The non surgical group had a mean gain +1.9kg/m2 (–4 – 10 kg/m2). Improvement in clinical parameters was also seen: insulin resistance (HOMA-IR) fell from 4.5 to 1.7, mean systolic blood pressure (mmHg) dropped 139 to 126, mean waist circumference (cm) from 121 to 116 cm, hepatic steatosis disappeared in 3 patients who demonstrated it and Vitamin D (µg/l) levels rose from 10 to 35.4. There were no significant complications. Constipation and nausea reported in 2 of the 4. All patients reported improvement in their well being. IWQOL improved mean scores in the body esteem domain increased from 48 to 81. BAI scores reduced from 22.5 to 5 in 2 patients.
Conclusion Multidisciplinary assessment is important in selecting patients for bariatric surgery. This surgery should be performed in centres that can provide this. Improvements in quality of life are significant and important to monitor to sustain weight loss. Longer term follow-up is necessary to maintain weight loss and monitor progress.