Dr. Janey S.A. Pratt, MD, FACS, FASMBS is a general surgeon who specializes in Robotic Hernia repair and Metabolic and Bariatric Surgery (MBS). She began her career in general surgery at Massachusetts General Hospital, where she was a founding member of the MGH Weight Center. As surgical director she introduced minimally invasive MBS and adolescent MBS to MGH in 2001 and 2007 respectively. In 2011 Dr. Pratt took over as Director at the MGH Weight Center and continued to work on several national committees towards improving access and care of adolescents with severe obesity. Dr. Pratt continued to practice general surgery through out her tenure at MGH seeing patients with breast cancer, hernias, and obesity. She performed advance minimally invasive surgery(MIS) as well as advanced endoscopy.
In 2016 Dr. Pratt moved to California where she began her work at Stanford University, splitting her time between the Lucille Packard Children’s Hospital and the Palo Alto VA. She performs Minimally Invasive MBS at both institutions as well as endoscopy. Dr. Pratt has trained in robotic surgery and performs robotic assisted hernia repairs on complex and simple hernias. As a Clinical Associate Professor of Surgery, Dr. Pratt is involved in training Stanford medical students and residents both in the OR, in the clinic, in the simulation labs and in the class room. Dr. Pratt is the associate program director of the VA MIS fellowship program, and Chair of the Pediatric Committee of the American Society for Metabolic and Bariatric Surgery.
Dr. Pratt has been involved in creating and updated guidelines for Adolescent MBS since 2005. In 2018 she was first author on the ASMBS Pediatric Metabolic and Bariatric Surgery Guidelines. Her other research interests include: MIS approaches to hernia repair and bowel obstruction, pediatric obesity treatment and the use of medications to improve outcomes of MBS. Dr. Pratt frequently lectures on the subject of Adolescent Metabolic and Bariatric Surgery.
- General Surgery
Clinical Professor, Surgery - Pediatric Surgery
Medical Education: Tufts University School of Medicine (1993) MA
Board Certification: American Board of Surgery, General Surgery (1999)
Residency: Massachusetts General Hospital (1998) MA
Internship: Massachusetts General Hospital (1994) MA
Trends in Adolescent Bariatric Procedures: a 15-Year Analysis of the National Inpatient Survey.
BACKGROUND: Adolescents with severe obesity achieve superior health outcomes following metabolic and bariatric surgery (MBS) than medical treatment alone. Surgery results in significant and sustained decrease in BMI and reduces associated comorbidity. We characterized the changing demographics of adolescents who had MBS over a 15-year time period.METHODS: Using ICD-9 and ICD-10 codes, the 2005-2019 National Inpatient Sample database was queried for patients<20years who underwent MBS. National trends, socio-demographics, and hospital resource utilization were analyzed.RESULTS: Between 2005 and 2019, there were 16,381 pediatric hospitalizations for MBS. The annual MBS procedures increased from 839 cases in 2005 to 1785 in 2019. There was a significant shift away from laparoscopic gastric bypass (LGB) to sleeve gastrectomy (SG). Initially, LGB represented 67% of cases with no SG. In 2019, SG constituted 85% of MBS procedures, while LGB comprised only 14%. Patients were predominantly female (76%) and White (56%). Over time, there were considerable increases in patients with public insurance (12 to 46%) and Hispanics (11 to 30%). There was also a shift away from urban, non-teaching hospitals to urban, teaching hospitals. The average length of stay (LOS) decreased, while mean charges remained similar.CONCLUSION: Our study demonstrates a gradual increase in the utilization of MBS among adolescents and a significant shift to SG. We observed a shift in MBS cases to teaching institutions, along with an increase in Hispanics and patients with public insurance. However, MBS remains underutilized, and effort should be made to increase early referral of adolescents for MBS evaluation.
View details for DOI 10.1007/s11695-022-06265-9
View details for PubMedID 36103080
Preventive Health Screening in Veterans Undergoing Bariatric Surgery.
American journal of preventive medicine
INTRODUCTION: Individuals with obesity are vulnerable to low rates of preventive health screening. Veterans with obesity seeking bariatric surgery are also hypothesized to have gaps in preventive health screening. Evaluation in a multidisciplinary bariatric surgery clinic is a point of interaction with the healthcare system that could facilitate improvements in screening.METHODS: This is a retrospective cohort study of 381 consecutive patients undergoing bariatric surgery at a Veterans Affairs Hospital from January 2010 to October 2021. Age- and sex-appropriate health screening rates were determined at initial referral to a multidisciplinary bariatric surgery clinic and at the time of surgery. Rates of guideline concordance at both time points were compared using McNemar's test. Univariate and multivariate analyses were performed to identify the risk factors for nonconcordance.RESULTS: Concordance with all recommended screening was low at initial referral and significantly improved by time of surgery (39.1%‒63.8%; p<0.001). Screening rates significantly improved for HIV (p<0.001), cervical cancer (p=0.03), and colon cancer (p<0.001). Increases in BMI (p=0.005) and the number of indicated screening tests (p=0.029) were associated with reduced odds of concordance at initial referral. Smoking history (p=0.012) and increasing distance to the nearest Veterans Affairs Medical Center (p=0.039) were associated with reduced odds of change from nonconcordance at initial referral to concordance at the time of surgery.CONCLUSIONS: Rates of preventive health screening in Veterans with obesity are low. A multidisciplinary bariatric surgery clinic is an opportunity to improve preventive health screening in Veterans referred for bariatric surgery.
View details for DOI 10.1016/j.amepre.2022.06.014
View details for PubMedID 36100538
Surgery for the treatment of obesity in children and adolescents.
The Cochrane database of systematic reviews
2022; 9: CD011740
Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences.To assess the effects of surgery for treating obesity in childhood and adolescence.For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews.We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant.We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information.With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/m2 (95% CI -13.22 to -9.58) and weight by -31.60 kg (95% CI -36.66 to -26.54) compared to a multi-component lifestyle programme at two years follow-up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow-up, laparoscopic gastric banding surgery may increase health-related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all-cause mortality, behaviour change, participants' views of the intervention and socioeconomic effects. Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents.Laparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.
View details for DOI 10.1002/14651858.CD011740.pub2
View details for PubMedID 36074911
Effect of telehealth implementation on an adolescent metabolic and bariatric surgery program.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
Pediatric severe obesity is a worldwide health concern. Treatment with metabolic and bariatric surgery can reduce morbidity and mortality. The COVID-19 pandemic not only has had a significant effect on rates of pediatric obesity but also has necessitated a rapid transition to virtual medicine.We aimed to identify and examine adolescent metabolic and bariatric surgery patient participation rates through our program's virtual telehealth programming as compared with prepandemic traditional in-person clinic appointments.This study took place at an academic pediatric quaternary care center.We evaluated 92 adolescent patients with a total of 2442 unique encounters between January 2018 and July 2021.The rate of attendance was found to be greater for telehealth visits (83.1%) than for in-person appointments (70.5%) for all clinics regardless of appointment type (preoperative versus postoperative). Cancellation rates were lower for telehealth visits (9.9%) than for in-person appointments (22.5%).This study provides evidence that telehealth can be implemented successfully in an adolescent metabolic and bariatric surgery program and can improve attendance rates for all provider and appointment subtypes.
View details for DOI 10.1016/j.soard.2022.05.014
View details for PubMedID 35753896
- Why earlier may be better: a look at the use of metabolic and bariatric surgery in the treatment of severe childhood obesity. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 2021
Bariatric Surgery is Safe for Patients After Recovery from COVID-19.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
BACKGROUND: Studies of patients who have undergone surgery while infected with COVID-19 have shown increased risks for adverse outcomes in both pulmonary complications and mortality. It has become clear that the risk of complications from perioperative COVID-19 infection must be weighed against the risk from delayed surgical treatment. Studies have also shown that prior bariatric surgery conveys protection against mortality from COVID-19 and that obesity is the biggest risk factor for mortality from COVID-19 infection in adults under 45 years of age. Studies in patients who have fully recovered from COVID-19 and underwent elective surgery have not become widely available yet.OBJECTIVES: This multi-institutional case series is presented to highlight patients who developed COVID-19, fully recovered, and subsequently underwent elective bariatric surgery with 30-day outcomes available.SETTING: Nine bariatric surgery centers located across the United States.METHODS: This multicenter case series is a retrospective chart review of patients who developed COVID-19, recovered, and subsequently underwent bariatric surgery. Fifty-three patients are included, and 30-day morbidity and mortality were analyzed.RESULTS: Thirty-day complications included esophageal spasm, dehydration, and ileus. There were no cardiovascular, venous thromboembolism (VTE) or respiratory events reported. There were no 30- day mortalities.CONCLUSIONS: Bariatric surgery has been safely performed in patients who made a full recovery from COVID-19 without increased complications due to cardiovascular, pulmonary, venous thromboembolism, or increased mortality rates.
View details for DOI 10.1016/j.soard.2021.07.018
View details for PubMedID 34446386
- Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities. Obesity surgery 2021
Pediatric Metabolic and Bariatric Surgery.
The Surgical clinics of North America
2021; 101 (2): 199–212
Childhood obesity can lead to comorbidities that cause significant decrease in health-related quality of life and early mortality. Recognition of obesity as a disease of polygenic etiology can help deter implicit bias. Current guidelines for treating severe obesity in children recommend referral to a multidisciplinary treatment center that offers metabolic and bariatric surgery at any age when a child develops a body mass index that is greater than 120% of the 95th percentile. Obesity medications and lifestyle counseling about diet and exercise are not adequate treatment for severe childhood obesity. Early referral can significantly improve quality and quantity of life.
View details for DOI 10.1016/j.suc.2020.12.007
View details for PubMedID 33743964
Outcomes of Bariatric Surgery in Older Versus Younger Adolescents.
OBJECTIVES: In this report, we compare weight loss, comorbidity resolution, nutritional abnormalities, and quality of life between younger and older adolescents after metabolic and bariatric surgery.METHODS: From March 2007 to December 2011, 242 adolescents (≤19 years of age) who underwent bariatric surgery at 5 clinical centers in the United States were enrolled in the prospective, multicenter, long-term outcome study Teen-Longitudinal Assessment of Bariatric Surgery. Outcome data from younger (13-15 years; n = 66) and older (16-19 years; n = 162) study participants were compared. Outcomes included percent BMI change, comorbidity outcomes (hypertension, dyslipidemia, and type 2 diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery.RESULTS: Baseline characteristics, except for age, between the 2 cohorts were similar. No significant differences in frequency of remission of hypertension (P = .84) or dyslipidemia (P = .74) were observed between age groups. Remission of type 2 diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; P = .046). Weight loss and quality of life were similar in the 2 age groups. Younger adolescents were less likely to develop elevated transferrin (prevalence ratio 0.52; P = .048) and low vitamin D levels (prevalence ratio 0.8; P = .034).CONCLUSIONS: The differences in outcome of metabolic and bariatric surgery between younger and older adolescents were few. These data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone and that providers should consider adolescents of all ages for surgical therapy for obesity when clinically indicated.
View details for DOI 10.1542/peds.2020-024182
View details for PubMedID 33526606
Experience With Vertical Sleeve Gastrectomy in Adolescent and Young Adult Ehlers-Danlos Syndrome Patients: a Case Series and Review of the Literature
View details for DOI 10.1007/s11695-021-05453-3
Considerations on the role of esophagogastroduodenoscopy in the pediatric metabolic and bariatric surgery patient
Surgery for Obesity and Related Diseases
View details for DOI 10.1016/j.soard.2021.07.010
- Patient experiences following botulinum toxin A injection for complex abdominal wall hernia repair. Journal of clinical anesthesia 2020; 66: 109956
Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity
SURGERY FOR OBESITY AND RELATED DISEASES
2020; 16 (3): 414-421
It is unknown whether previously noted racial disparities in the use of metabolic and bariatric surgery (MBS) for the management of pediatric obesity could be mitigated by accounting for primary insurance.To examine utilization of pediatric MBS across race and insurance in the United States.Retrospective cross-sectional study.The National Inpatient Sample was used to identify patients 12 to 19 years old undergoing MBS from 2015 to 2016, and these data were combined with national estimates of pediatric obesity obtained from the 2015 to 2016 National Health and Nutrition Examination Survey. Severe obesity was defined as class III obesity, or class II obesity plus hypertension, dyslipidemia, or type 2 diabetes.A total of 1,659,507 (5.0%) adolescents with severe obesity were identified, consisting of 35.0% female, 38.0% white, and 45.0% privately insured adolescents. Over the same time period, 2535 MBS procedures were performed. Most surgical patients were female (77.5%), white (52.8%), and privately insured (57.5%). Black and Hispanic adolescents were less likely to undergo MBS than whites (odds ratio .50, .46, respectively; P < .001 both), despite adjusting for primary insurance. White adolescents covered by Medicaid were significantly more likely to undergo MBS than their privately insured counterparts (odds ratio 1.66; P < .001), while the opposite was true for black and Hispanic adolescents (odds ratio .29, .75, respectively; P < .001 both).Pediatric obesity disproportionately affects racial minorities, yet MBS is most often performed on white adolescents. Medicaid insurance further decreases the use of MBS among nonwhite adolescents, while paradoxically increasing it for whites, suggesting expansion of government-sponsored insurance alone is unlikely to eliminate this race-based disparity.
View details for DOI 10.1016/j.soard.2019.11.020
View details for Web of Science ID 000518233600007
View details for PubMedID 31917198
View details for PubMedCentralID PMC7058484
Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery.
Seminars in pediatric surgery
2020; 29 (1): 150890
To ensure successful outcomes in pediatric patients with severe obesity who undergo metabolic and bariatric surgery (MBS), a number of pre-operative patient management options should be considered. This manuscript will review the indications and contraindications of MBS and special considerations for youth who might benefit from MBS. The treatment team conducts a thorough pre-operative evaluation, assessing risks and benefits of surgical intervention, and prepares patients and families to be successful with MBS by providing education about the surgical intervention and lifestyle changes that will be necessary. This article reviews the pre-operative considerations for adolescents with severe obesity who are being considered for MBS, based upon recent clinical practice guidelines.
View details for DOI 10.1016/j.sempedsurg.2020.150890
View details for PubMedID 32238283
Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults.
Frontiers in endocrinology
2020; 11: 157
Objective: We sought to compare the short and long-term outcomes of MBS in adolescents vs. adults who have undergone a Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG). Design: Retrospective cohort study. Setting: Single tertiary care academic referral center. Participants: One hundred fifty adolescent (≤ 21-years) and adult (>21-years) subjects with severe obesity between 15 and 70 years of age who underwent RYGB or SG. Outcomes: Metabolic parameters, weight and height measures were obtained pre-and post-surgery (at 3 and 6 months, and then annually for 4 years). Results: Median pre-surgical body mass index (BMI) was higher in adolescents (n = 76) vs. adults (n = 74): 50 (45-57) vs. 44 (40-51) kg/m2 (p < 0.0001). However, obesity related complications were greater in adults vs. adolescents: 66 vs. 21% had hypertension, 68 vs. 28% had dyslipidemia, and 42 vs. 21% had type 2 diabetes mellitus (all p < 0.010). % BMI reduction and % weight loss (WL) were greater in adolescents vs. adults at all time points (p < 0.050). %WL was higher in adolescents who underwent SG at each time point (p < 0.050), and trended higher among adolescents who underwent RYGB (p = 0.060), compared to adults with the respective procedure. Follow-up data showed greater resolution of type 2 diabetes and hypertension in adolescents than adults (87.5 vs. 54.8%; p = 0.04, and 68.7 vs. 35.4%; p = 0.040). Conclusion: Adolescents compared to adults had greater reductions in BMI and weight, even at 4 years, and greater resolution of type 2 diabetes and hypertension. Earlier intervention in the treatment of severe obesity with MBS may lead to better outcomes.
View details for DOI 10.3389/fendo.2020.00157
View details for PubMedID 32265846
View details for PubMedCentralID PMC7105703
Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery.METHODS: A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy.RESULTS: There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p=0.000) and steatosis (100.0% versus 59.4%, p=0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p=0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1mIU/L, p=0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p=0.033) and alanine aminotransferase (81.5 versus 52.7mg/dL, p=0.043). There were no biopsy complications or changes in management due to biopsy results.CONCLUSIONS: Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.
View details for DOI 10.1007/s11695-019-04136-4
View details for PubMedID 31446562
Slipped capital femoral epiphysis and Blount disease as indicators for early metabolic surgical intervention.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
BACKGROUND: Slipped capital femoral epiphysis (SCFE) and Blount disease are strongly associated with pediatric obesity, yet they have only recently been identified as indications for consideration of metabolic and bariatric surgery (MBS).OBJECTIVES: To describe the relationships between pediatric obesity, MBS, SCFE, and Blount disease.SETTING: Nationwide database.METHODS: The national inpatient sample was used to identify patients ≤20 years old with obesity who underwent MBS from 2007 to 2016. Presence of SCFE and Blount disease was similarly extracted.RESULTS: The overall prevalence of SCFE and Blount disease among patients ≤20 years old is .02% for both (14,976, 11,238 patients, respectively) with no statistically significant change over the study period (P = .68, .07, respectively). The rates of SCFE and Blount disease in children with and without obesity are .46% versus .02% and .36% versus .01%, respectively (P < .001 for both). The mean age of patients with SCFE and obesity was 12 years old, while the mean age of those without obesity was 12.2 years old (P = .03). None of the children with obesity and SCFE underwent MBS. Similarly, the mean age of patients with Blount disease and obesity was 12.6 years old, while the mean age of those without obesity was 13.1 years old. Moreover, the mean age of children with Blount disease and obesity who underwent MBS was 16 years old (P < .001).CONCLUSIONS: Orthopedic complications remain a persistent problem in the pediatric population who suffer from obesity. Despite being diagnosed at a young age, patients with SCFE and/or Blount disease are not undergoing MBS until their later adolescent years, potentially leading to unnecessary disease progression or recurrence of disease after orthopedic interventions. Therefore, SCFE and Blount disease should be considered indications for early consideration of MBS in this pediatric population.
View details for DOI 10.1016/j.soard.2019.06.024
View details for PubMedID 31519488
Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity.
Obesity (Silver Spring, Md.)
2019; 27 (2): 190–204
A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the application of obesity pharmacotherapy remains largely underutilized. These youth often present with numerous obesity-related comorbid diseases, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and psychosocial issues such as depression, anxiety, and social stigmatization. Current pediatric obesity treatment algorithms for pediatric primary care providers focus primarily on intensive lifestyle intervention with escalation of treatment intensity through four stages of intervention. Although a recent surge in the number of Food and Drug Administration-approved medications for obesity treatment has emerged in adults, pharmacotherapy options for youth remain limited. Recognizing treatment and knowledge gaps related to pharmacological agents and the urgent need for more effective treatment strategies in this population, discussed here are the efficacy, safety, and clinical application of obesity pharmacotherapy in youth with obesity based on current literature. Legal ramifications, informed consent regulations, and appropriate off-label use of these medications in pediatrics are included, focusing on prescribing practices and prescriber limits.
View details for PubMedID 30677262
- Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity OBESITY 2019; 27 (2): 190–204
- Comment on: body contouring in adolescents after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 2019
Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study.
Bariatric surgical practice and patient care
2018; 13 (4): 171-178
Weight loss medications are effective to confer additional weight loss after bariatric surgery in the general population, but they have not been evaluated in adults 60 years of age and older. We performed a retrospective study identifying 35 patients who were ≥60 years old and had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2000 to 2014, and were subsequently prescribed weight loss medications. Linear regression analyses were performed to determine beta coefficients of certain predictor variables being associated with weight loss. Patients lost weight on medications with an average body mass index (BMI) change of -2.74 kg/m2, standard deviation = 2.6 kg/m2. RYGB patients lost a greater percentage of BMI on medication than SG (SG; -1.38 ± 1.49 kg/m2 and RYGB; -3.37 ± 2.83 kg/m2, p = 0.0372). Patients with hypertension were less likely to lose weight on medications (β = 16.76, p = 0.004, and 95% confidence interval = 5.85-27.67). Weight loss medications are a useful treatment to confer additional weight loss in adults 60 years of age and older after RYGB and SG.
View details for DOI 10.1089/bari.2018.0037
View details for PubMedID 30595995
View details for PubMedCentralID PMC6306651
- National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity JAMA PEDIATRICS 2018; 172 (12): 1191–92
National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity.
View details for PubMedID 30357351
- Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study BARIATRIC SURGICAL PRACTICE AND PATIENT CARE 2018
- Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study CHILDREN-BASEL 2018; 5 (9)
Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study.
Children (Basel, Switzerland)
2018; 5 (9)
This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (-8.1%) than SG (-3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (-6.0%) versus after weight regain (-5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was -2.9% compared to the rest of the cohort at -7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions.
View details for PubMedID 30158481
ASMBS pediatric metabolic and bariatric surgery guidelines, 2018.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
2018; 14 (7): 882–901
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
View details for PubMedID 30077361
- ASMBS pediatric metabolic and bariatric surgery guidelines, 2018 SURGERY FOR OBESITY AND RELATED DISEASES 2018; 14 (7): 882–901
Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study
WORLD JOURNAL OF GASTROENTEROLOGY
2018; 24 (19): 2108–19
To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.
View details for PubMedID 29785079
View details for PubMedCentralID PMC5960816
- Adolescent Bariatric Surgery and Thiamine Deficiency: What Do We Know So Far? Response PEDIATRICS 2017; 140 (2)
The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study
SURGERY FOR OBESITY AND RELATED DISEASES
2017; 13 (3): 491-500
Patients who undergo bariatric surgery often have inadequate weight loss or weight regain.We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.Two academic medical centers.We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000-2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy.A total of 319 patients (RYGB = 258; sleeve gastrectomy = 61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing≥10% (16.7 to 195.2 lbs) and≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio = 1.9; P = .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose≥5% of their total weight with the aid of weight loss medications.Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.
View details for DOI 10.1016/j.soard.2016.10.018
View details for Web of Science ID 000398016500021
A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States.
Journal of pediatric surgery
Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents.A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications.Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA.LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents.Descriptive case series with prospective database.IV.
View details for PubMedID 28697852
- Wernicke Encephalopathy in Adolescents After Bariatric Surgery: Case Report and Review PEDIATRICS 2016; 138 (6)
Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy
FRONTIERS IN PEDIATRICS
2016; 4: 78
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.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.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.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.
View details for DOI 10.3389/fped.2016.00078
View details for Web of Science ID 000380341900001
View details for PubMedID 27508205
View details for PubMedCentralID PMC4960456
Wernicke Encephalopathy in Adolescents After Bariatric Surgery: Case Report and Review.
2016; 138 (6)
Roughly 1% of all weight loss surgery is performed in adolescents. There is strong evidence demonstrating significant postsurgical weight loss, improvement in quality of life, and reduction in comorbidities such as hypertension and diabetes. Reports of postoperative complications in adolescents are few because of the small sample size in most series. Despite vitamin supplementation, nutritional deficiencies requiring hospitalization occur occasionally after Roux-en-Y gastric bypass. Wernicke encephalopathy, a triad of ophthalmoplegia, ataxia, and altered mental status, is a serious consequence of thiamine (vitamin B1) deficiency. Few cases of Wernicke encephalopathy after weight loss surgery have been reported in the literature and even fewer in the pediatric population. Here we describe a teenage girl who develops vomiting after Roux-en-Y gastric bypass and presented with nystagmus, irritability, and ataxia. The clinical presentation, diagnosis, and treatment of Wernicke encephalopathy in adolescents after bariatric surgery are discussed.
View details for PubMedID 27940680
Posterior reversible encephalopathy syndrome (PRES) after bariatric surgery--a potential consequence associated with rapid withdrawal of antihypertensive medications.
BMJ case reports
A 61-year-old woman with a medical history of intracerebral haemorrhage, hypertension, hyperlipidaemia and carotid stenosis presented to the emergency department with altered mental status 3 weeks after undergoing a vertical sleeve gastrectomy for severe obesity. She presented with a hypertensive emergency and a National Institutes of Health Stroke Scale of 4. CT of the head was unrevealing. MRI showed an abnormal signal within the bilateral posterior border-zone areas, with several foci in the parietal and occipital lobes, and thalami, suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was initially placed on a labetalol drip and her preoperative antihypertensive medications--amlodipine, captopril, triamterene and hydrochlorothiazide--were gradually reintroduced. She returned to her baseline and was stable on discharge. Rapid withdrawal of antihypertensive medications in the early postoperative period of bariatric surgery was the aetiology of PRES in this patient. This case report discusses postoperative care of bariatric surgery patients having hypertension.
View details for DOI 10.1136/bcr-2015-212290
View details for PubMedID 26698202
The Importance of Interdisciplinary Research Training and Community Dissemination
CTS-CLINICAL AND TRANSLATIONAL SCIENCE
2015; 8 (5): 611-614
Funding agencies and institutions are creating initiatives to encourage interdisciplinary research that can be more easily translated into community initiatives to enhance health. Therefore, the current research environment calls for interdisciplinary education and skills to create sustained partnerships with community institutions. However, formalized opportunities in both of these areas are limited for students embarking on research careers. The purpose of this paper is to underscore the historical and current importance of providing interdisciplinary training and community dissemination for research students. We also suggest an approach to begin to address the existing gap. Specifically, we suggest embedding a 10-week summer rotation into existing research curricula with the goals of: (1) providing students with a hands-on interdisciplinary research experience, (2) facilitating dialogue between research students and community settings to disseminate science to the public, and (3) sparking collaborations among researchers who seek to create a way to sustain summer program rotations with grant funding.
View details for DOI 10.1111/cts.12330
View details for Web of Science ID 000363652100034
View details for PubMedID 26508528
View details for PubMedCentralID PMC4625396
NUTRITION Metabolic and bariatric surgery Nutrition and dental considerations
JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
2015; 146 (10): 767-772
Oral health care professionals may encounter patients who have had bariatric surgery and should be aware of the oral and nutritional implications of these surgeries. Bariatric surgery is an effective therapy for the treatment of obesity. Consistent with the 1991 National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity recommendations, patients must meet body mass index (BMI) criteria for severe obesity, defined as a BMI greater than or equal to 40 kilograms per square meter, as well as for those with a BMI of greater than or equal to 35 kg/m(2) with significant comorbidities.Benefits of bariatric surgery in the treatment of severe obesity include significant and durable weight loss and improved or remission of obesity-related comorbidities including type 2 diabetes, hyperlipidemia, hypertension, heart disease, obstructive sleep apnea, and depression. Of the limited data published concerning the influences of bariatric surgical procedures on oral health, increased incidence of dental caries, periodontal diseases, and tooth wear have been reported in patients post-bariatric surgery.The oral health care practitioner familiar with the most common bariatric procedures performed in the United States and their mechanisms of actions, risks, and benefits is in the position to provide guidance to patients on the nutritional and oral complications that can occur.
View details for DOI 10.1016/j.adaj.2015.06.004
View details for Web of Science ID 000367340600012
View details for PubMedID 26409987
Two-Year Changes in Bone Density After Roux-en-Y Gastric Bypass Surgery
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
2015; 100 (4): 1452-1459
Bariatric surgery is increasingly popular but may lead to metabolic bone disease.The objective was to determine the rate of bone loss in the 24 months after Roux-en-Y gastric bypass.This was a prospective cohort study conducted at an academic medical center.The participants were adults with severe obesity, including 30 adults undergoing gastric bypass and 20 nonsurgical controls.We measured bone mineral density (BMD) at the lumbar spine and proximal femur by quantitative computed tomography (QCT) and dual-energy x-ray absorptiometry at 0, 12, and 24 months. BMD and bone microarchitecture were also assessed by high-resolution peripheral QCT, and estimated bone strength was calculated using microfinite element analysis.Weight loss plateaued 6 months after gastric bypass but remained greater than controls at 24 months (-37 ± 3 vs -5 ± 3 kg [ mean ± SEM]; P < .001). At 24 months, BMD was 5-7% lower at the spine and 6-10% lower at the hip in subjects who underwent gastric bypass compared with nonsurgical controls, as assessed by QCT and dual-energy x-ray absorptiometry (P < .001 for all). Despite significant bone loss, average T-scores remained in the normal range 24 months after gastric bypass. Cortical and trabecular BMD and microarchitecture at the distal radius and tibia deteriorated in the gastric bypass group throughout the 24 months, such that estimated bone strength was 9% lower than controls. The decline in BMD persisted beyond the first year, with rates of bone loss exceeding controls throughout the second year at all skeletal sites. Mean serum calcium, 25(OH)-vitamin D, and PTH were maintained within the normal range in both groups.Substantial bone loss occurs throughout the 24 months after gastric bypass despite weight stability in the second year. Although the benefits of gastric bypass surgery are well established, the potential for adverse effects on skeletal integrity remains an important concern.
View details for DOI 10.1210/jc.2014-4341
View details for Web of Science ID 000353361500053
View details for PubMedID 25646793
View details for PubMedCentralID PMC4399296
Prevalence and outcome of non-alcoholic fatty liver disease in adolescents and young adults undergoing weight loss surgery
2014; 9 (5): E91-E93
We evaluated the prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) in 27 adolescents referred for weight loss surgery (WLS).On biopsy, 18 patients (66.7%) had NAFLD, and of those, 10 (37.0%) had NASH and 11 (40.7%) had fibrosis. Insulin, HbA1C and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher in patients with NASH than those without NASH. Following WLS, 40% of patients with NASH had persistently elevated aminotransferase levels despite weight loss.We found that NASH is underdiagnosed in adolescents referred for WLS, and that hyperinsulinaemia, HOMA-IR and HbA1c can aid in identifying high-risk patients.
View details for DOI 10.1111/j.2047-6310.2014.219.x
View details for Web of Science ID 000342991900004
View details for PubMedID 24677740
View details for PubMedCentralID PMC4163105
Metabolic Effects of Roux-en-Y Gastric Bypass in Obese Adolescents and Young Adults
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
2013; 56 (5): 528-531
Weight loss surgery is an increasingly common treatment option for obese adolescents, but data are limited regarding the metabolic effects of surgical weight loss procedures. We performed a retrospective review of the electronic medical record to determine metabolic outcomes for 24 adolescents and young adults ages 15 to 22 years undergoing Roux-en-Y gastric bypass from 2009 to 2011 as well as 24 age-, sex-, and BMI-matched controls. During a median follow-up of 6 months after Roux-en-Y gastric bypass, fasting glucose, hemoglobin A1c, low-density lipoprotein, triglyceride, and high-sensitivity C-reactive protein decreased significantly. Changes in these measures were not significantly associated with age or extent of weight loss.
View details for DOI 10.1097/MPG.0b013e318283910c
View details for Web of Science ID 000318021900020
View details for PubMedID 23274343
View details for PubMedCentralID PMC3637417
- Bariatric surgery in children: how can we combat the prejudice? CIRUGIA ESPANOLA 2012; 90 (10): 617-618
- ASMBS pediatric committee best practice guidelines SURGERY FOR OBESITY AND RELATED DISEASES 2012; 8 (1): 1-7
Practical Approaches to the Treatment of Severe Pediatric Obesity
PEDIATRIC CLINICS OF NORTH AMERICA
2011; 58 (6): 1425-+
Pediatric obesity is a major public health threat. Obese children and adolescents are at increased risk for many medical and surgical conditions. These conditions may affect their quality of life and life expectancy. The rapidly progressive nature of type 2 diabetes mellitus within the first 5 years of obesity diagnosis is particularly concerning. Because health risk increases with degree of obesity, adolescents who may be eligible for more aggressive obesity treatment should be identified and counseled.
View details for DOI 10.1016/j.pcl.2011.09.013
View details for Web of Science ID 000298311700008
View details for PubMedID 22093860
Panel report: best practices for the surgical treatment of obesity
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
2011; 25 (6): 1730-1740
Bariatric surgery is a rapidly growing field. Advances in surgical technologies and techniques have raised concerns about patient safety. Bariatric surgeons and programs are under increased scrutiny from regulatory agencies, insurers, and public health officials to provide high quality and safe care for bariatric patients at all phases of care.During the 2009 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on patient safety and best practices in bariatric surgery. The following article is a summary of this panel presentation.Weight loss surgery is a field that is evolving and adapting to multiple external pressures. Safety concerns along with increasing public scrutiny have led to a systematic approach to defining best practices, creating standards of care, and identifying mechanisms to ensure that patients consistently receive the best and most effective care possible. In many ways, bariatric surgery and multidisciplinary bariatric surgery programs may serve as a model for other programs and surgical specialties in the near future.
View details for DOI 10.1007/s00464-010-1487-y
View details for Web of Science ID 000290806200004
View details for PubMedID 21136099
Medical and surgical treatment of obesity
BEST PRACTICE & RESEARCH-CLINICAL ANAESTHESIOLOGY
2011; 25 (1): 11-25
The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. Medical treatments of obesity include primary prevention, dietary intervention, increased physical activity, behavior modification, and pharmacotherapy. Surgical treatment for obesity is based on the extensive neural-hormonal effects of weight loss surgery on metabolism, and as such is better termed Metabolic Surgery. Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity.
View details for DOI 10.1016/j.bpa.2011.01.001
View details for Web of Science ID 000215396400003
View details for PubMedID 21516910
Best Practice Updates for Pediatric/Adolescent Weight Loss Surgery
2009; 17 (5): 901-910
The objective of this study is to update evidence-based best practice guidelines for pediatric/adolescent weight loss surgery (WLS). We performed a systematic search of English-language literature on WLS and pediatric, adolescent, gastric bypass, laparoscopic gastric banding, and extreme obesity published between April 2004 and May 2007 in PubMed, MEDLINE, and the Cochrane Library. Keywords were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. In light of evidence on the natural history of obesity and on outcomes of WLS in adolescents, guidelines for surgical treatment of obesity in this age group need to be updated. We recommend modification of selection criteria to include adolescents with BMI >or= 35 and specific obesity-related comorbidities for which there is clear evidence of important short-term morbidity (i.e., type 2 diabetes, severe steatohepatitis, pseudotumor cerebri, and moderate-to-severe obstructive sleep apnea). In addition, WLS should be considered for adolescents with extreme obesity (BMI >or= 40) and other comorbidities associated with long-term risks. We identified >1,085 papers; 186 of the most relevant were reviewed in detail. Regular updates of evidence-based recommendations for best practices in pediatric/adolescent WLS are required to address advances in technology and the growing evidence base in pediatric WLS. Key considerations in patient safety include carefully designed criteria for patient selection, multidisciplinary evaluation, choice of appropriate procedure, thorough screening and management of comorbidities, optimization of long-term compliance, and age-appropriate fully informed consent.
View details for DOI 10.1038/oby.2008.577
View details for Web of Science ID 000265709800009
View details for PubMedID 19396070
View details for PubMedCentralID PMC3235623
Expert Panel on Weight Loss Surgery: Executive Report Update
2009; 17 (5): 842-862
Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
View details for DOI 10.1038/oby.2008.578
View details for Web of Science ID 000265709800002
View details for PubMedID 19396063
Best Practice Updates for Informed Consent and Patient Education in Weight Loss Surgery
2009; 17 (5): 885-888
To update evidence-based best practice guidelines for obtaining informed consent from weight loss surgery (WLS) patients, with an emphasis on appropriate content and communications approaches that might enhance patient understanding of the information, we performed a systematic search of English-language literature published between April 2004 and May 2007 in MEDLINE and the Cochrane database. Keywords included WLS and informed consent, comprehension, health literacy, and patient education; and WLS and outcomes, risk, patient safety management, and effectiveness. Recommendations are based on the most current literature and the consensus of the expert panel; they were graded according to systems used in established evidence-based models. We identified over 120 titles, 38 of which were reviewed in detail. Evidence suggests that WLS outcomes, including long-term rates of relapse, vary by procedure. For some weight loss surgeries, long-term outcomes may not be known. Risks also vary by patient and provider characteristics. Informed consent should incorporate realistic projections of the short- and long-term risks, benefits, and consequences of surgery, as well as alternatives to WLS. For consent to be informed, the education process should continue until the patient demonstrates comprehension of all relevant material and concepts. Confirmation of comprehension can protect patients engaged in the process of consent for WLS. Future research should focus on the outcomes and consequences of WLS, and different approaches that facilitate patient understanding of, and decision making about, WLS.
View details for DOI 10.1038/oby.2008.567
View details for Web of Science ID 000265709800006
View details for PubMedID 19396067
The tethered bezoar as a delayed complication of laparoscopic Roux-en-Y gastric bypass: A case report
JOURNAL OF GASTROINTESTINAL SURGERY
2007; 11 (5): 690-692
Known complications of Roux-en-Y gastric bypass causing abdominal pain and obstructive symptoms include biliary colic, anastomotic ulcer, anastomotic stenosis, or internal hernia. This case report describes a new complication in a patient 15 months post-bypass: a bezoar at the gastrojejunal anastomosis, the nidus of which was a length of permanent suture material which had eroded through the gastric wall. We include endoscopic images of the bezoar, a review of the related gastric bypass literature, and describe the changes made in our practice as a result of this complication.
View details for DOI 10.1007/s11605-007-0098-y
View details for Web of Science ID 000246184000020
View details for PubMedID 17468931
Effectiveness of Haptic Feedback in Open Surgery Simulation and Training Systems
IOS PRESS. 2006: 213-+
This paper presents progress in the development of an untethered haptic feedback system for open surgery simulation and training being developed by Energid Technologies. A key innovation in our simulation is an untethered haptic feedback method. In this paper, we describe our approach to developing an effective untethered haptic feedback system, and our current progress. We also present the results of a haptic feedback effectiveness study which explores how haptic rendering accuracy behaves as a function of sampling rate for tool tracking.
View details for Web of Science ID 000269690200046
View details for PubMedID 16404047
The Surgical Simulation and Training Markup Language (SSTML): An XML-Based Language for Medical Simulation
IOS PRESS. 2006: 37-+
Under contract with the Telemedicine & Advanced Technology Research Center (TATRC), Energid Technologies is developing a new XML-based language for describing surgical training exercises, the Surgical Simulation and Training Markup Language (SSTML). SSTML must represent everything from organ models (including tissue properties) to surgical procedures. SSTML is an open language (i.e., freely downloadable) that defines surgical training data through an XML schema. This article focuses on the data representation of the surgical procedures and organ modeling, as they highlight the need for a standard language and illustrate the features of SSTML. Integration of SSTML with software is also discussed.
View details for Web of Science ID 000269690200008
View details for PubMedID 16404009
Best practice guidelines in pediatric/adolescent weight loss surgery
2005; 13 (2): 274-282
To establish evidence-based guidelines for best practices in pediatric/adolescent weight loss surgery (WLS).We carried out a systematic search of English-language literature in MEDLINE on WLS performed on children and adolescents. Key words were used to narrow the field for a selective review of abstracts. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Eight pertinent case series, published between 1980 and 2004, were identified and reviewed. These data were supplemented with expert opinions and literature on WLS in adults.Recommendations focused on patient safety, reduction of medical errors, systems improvements, credentialing, and future research. We developed evidence-based criteria for eligibility, assessment, treatment, and follow-up; recommended surgical procedures based on the best available evidence; and established minimum guideline requirements for data collection.Lack of adequate data and gaps in knowledge were cited as important reasons for caution. Physiological status, comprehensive screening of patients and their families, and required education and counseling were identified as key factors in assessing eligibility for surgery. Data collection and peer review were also identified as important issues in the delivery of best practice care.
View details for DOI 10.1038/oby.2005.37
View details for Web of Science ID 000228238100009
View details for PubMedID 15800284
Best practice guidelines on informed consent for weight loss surgery patients
2005; 13 (2): 250-253
To provide evidence-based guidelines on informed consent and the education that underlies it for legally competent, severely obese weight loss surgery (WLS) patients.We conducted a systematic review of the scientific literature published on MEDLINE between 1984 and 2004. Three articles focused on informed consent for WLS; none was based on empirical studies. We summarized each paper and assigned evidence categories according to a grading system derived from established evidence-based models. We also relied on informed consent and educational materials from six WLS programs in Massachusetts. All evidence is Category D. Recommendations were based on a review of the available literature, informed consent materials from WLS programs, and expert opinion.This Task Group found that the informed consent process contributes to long-term outcome in multiple ways but is governed by limited legal requirements. We focused our report on the legal and ethical issues related to informed consent, i.e., disclosure vs. comprehension. Recommendations centered on the importance of assessing patient comprehension of informed consent materials, the content of those materials, and the use of active teaching/learning techniques to promote understanding.Although demonstrated comprehension is not a legal requirement for informed consent in Massachusetts or other states, the members of this Task Group found that the best interests of WLS patients, providers, and facilities are served when clinicians engage patients in active learning and collaborative decision making.
View details for DOI 10.1038/oby.2005.34
View details for Web of Science ID 000228238100006
View details for PubMedID 15800281
- Case 25-2004: A woman with severe obesity, diabetes, and hypertension NEW ENGLAND JOURNAL OF MEDICINE 2004; 351 (26): 2771-2772
- Case 25-2004: A 49-year-old woman with severe obesity, diabetes, and hypertension NEW ENGLAND JOURNAL OF MEDICINE 2004; 351 (7): 696-705