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Adolescent bariatric surgery

AMOS: Gastric bypass benefits most adolescents

Self-esteem, self-concept and overall mood improved significantly, with improvements mainly observed during the first year after surgery

Teenagers suffering from severe obesity generally feel worse than their peers, but after undergoing gastric bypass nearly all experience improved mental health. One in five, however, still suffers from symptoms of depression - some quite seriously. These are the results of a study, ‘Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity.’ from Lund University in Sweden, published in Obesity.

The Adolescent Morbid Obesity Surgery (AMOS) study is the largest two-year follow-up in the world regarding mental health in adolescents who have undergone a form of weight-loss surgery known as gastric bypass. It includes 88 Swedish adolescents, 13-18 years old, with an average BMI 45.6 prior to surgery.

Many operations on young people have been carried out in Sweden, where healthcare is free, compared to in the rest of the world. Other countries, such as Denmark, do not allow weight-loss surgery for patients under the age of 25, and in the US you need health insurance to cover the procedure. The Swedish study is therefore based on an internationally unique and large group of patients.

"Most young people felt significantly better two years after surgery. On average, they felt like most other adolescents, so their mental health had been normalised," said Kajsa Järvholm, a researcher and psychologist at Lund University. "There is also a big difference in how weight affected them in various social situations. Two years after the operation, they experienced far fewer limitations than before."

A total of 88 adolescents (65% girls) aged 13 to 18 years were assessed at baseline and one and two years after surgery. Generic and obesity-specific questionnaires were used to evaluate outcomes in mental health, also in relation to age- and gender-specific norms.

Symptoms of anxiety (p=0.001), depression (p=0.001), anger (p=0.001), and disruptive behaviour (p=0.022) were significantly reduced at two years after surgery, as were obesity-related problems (p<0.001). Self-esteem (p<0.001), self-concept (p<0.001), and overall mood (p=0.025) improved significantly. Improvements were mainly observed during the first year after surgery. The second year was characterised by stabilisation. Symptoms of anxiety, depression, anger, disruptive behaviour, and self-concept were at normative levels after surgery. However, 19% of the adolescents had depressive symptoms in the clinical range.

"Another important discovery was that some did not feel better. Just under 20 per cent of patients said they still did not feel well after having surgery, and their self-assessments showed symptoms of moderate to severe depression. 13 per cent showed symptoms of severe depression," she explained.

Järvholm believes that it is important to continue studying the group of adolescent patients. She also considers it necessary to provide psychosocial support for young people undergoing gastric bypass surgery, especially those who do not feel better mentally even if they lost weight.

"More measures are needed to identify groups at risk and to provide the help and support they need," she explained.

The researchers want to investigate whether undergoing surgery before turning 18 rather than as an adult will have different results in terms of preventing disease, maintaining weight, and mental health. The study also examines whether there are differences in future developments in life, for example with regard to work and family, if one undergoes surgery before turning 18.

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