Most recent update: Friday, November 15, 2019 - 09:33

Bariatric News - Cookies & privacy policy

You are here

Cognitive functioning and surgery

Cognitive functioning not a predictor of weight-loss for adolescents

Having CI/DD did not significantly impact weight loss or weight loss trajectory in the two years after surgery, although modelling revealed a trend toward individuals with CI/DD losing more weight over time

Young people with cognitive impairments and developmental disabilities (CI/DD), including Down syndrome, have similar weight-loss trajectories to those with typical cognitive function after bariatric surgery, according to a study by psychologists at Children's National Health System, Washington DC. Though young people with intellectual disabilities or cognitive impairment have greater rates of obesity and other comorbidities that impact their health and well-being, primary care providers are often reluctant to discuss or refer these patients for bariatric surgery due to concerns about their ability to assent to both the surgery and the ongoing diet and lifestyle changes after surgery.

The study, ‘Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability’, published in Pediatrics, is the first to look at post-surgical outcomes for this subgroup of adolescent bariatric surgery patients. The authors recommend making the determination on a case-by-case basis. This study adds to the body of research that is helping to create standard criteria for bariatric surgery in adolescents and teenagers.

Sarah Hornack

"It's challenging to ensure that an adolescent who is cognitively impaired understands what it means to undergo a surgical procedure like bariatric surgery, but we do find ways to ensure assent whenever possible, and make sure the patient also has a guardian capable of consent," said Dr Sarah Hornack, a clinical psychologist at Children's National and the study's first author. "A very important determinant of post-surgical success for any young candidate, however, is a support structure to help them with weight-loss surgery requirements. Often, we see that adolescents with lower cognitive function already have a well-established support system in place to assist them with other care needs, that can easily adapt to providing structure and follow through after weight-loss surgery, too."

In the study, the authors reviewed outcomes for 63 adolescents ranging in age from 13 to 24 years old with an average BMI of 51.2, all of whom were part of the bariatric surgery programme at Children's National Health System. The participants were diagnosed with cognitive impairment or intellectual disability via standardised cognitive assessments as part of a pre-operative psychological evaluation or through a previous diagnosis.

They reported that there were no significant differences between adolescents with or without CI/DD in terms of preoperative BMI, age, and sex. Furthermore, having CI/DD did not significantly impact weight loss or weight loss trajectory in the two years after surgery, although modelling revealed a trend toward individuals with CI/DD losing more weight over time. Similarly, intelligence scores did not predict weight loss after surgery.

“Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD,” the researchers concluded. “They could benefit from the surgery as much as those with typical development and having CI/DD should not be used as a criterion to deny surgery. Continuing research with this population can be used to determine long-term outcomes in addition to defining best practices.”

Eleanor Mackey

"We're happy to contribute evidence that can help families and care providers make informed health decisions for young people with intellectual disabilities or cognitive impairments. So many families are hoping to make sure that their children, despite disabilities, can be as healthy as possible in the long term," said Dr Eleanor Mackey, who is also a clinical psychologist at Children's National and served as the study's senior author. "Though the sample size is small, it does give credence to the idea that for many adolescents and teenagers, weight loss surgery may be a really viable option regardless of pre-existing conditions such as intellectual ability or cognitive function."

Children's National is one of only a few children's hospitals with accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery to offer bariatric surgery for adolescents with severe obesity. The extraordinary diversity of the patient population in Washington DC, including high rates of young people with obesity, allows the team to collect more comprehensive information about successful interventions across subgroups, including cognitive impairment or developmental disabilities, than nearly every other centre in the United States.

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.