Adolescences who undergo Roux-en-Y gastric bypass (RYGB) should be provided with management strategies to reduce their post-operative energy intake, according to a multi-centre study by Swedish researchers. The researchers stated that by monitoring post-op eating-related problems potential individuals at risk of poor weight loss could be identified and possible treatment interventions could be initiated. The findings were reported in the paper, ‘Long-term changes in dietary intake and its association to eating-related problems after gastric bypass in adolescents’, published in SOARD.
The investigators explained that there are limited papers that have reported the relationship between dietary intake and eating-related problems after bariatric surgery, and even fewer papers reporting on adolescence eating behaviour and bariatric surgery. Therefore, they established the study to assess the changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems. The study is part of the Swedish nationwide multi-centre study, Adolescent Morbid Obesity Surgery study (AMOS), which is a prospective non-randomised comparative observational study examining the long-term safety and efficacy of RYGB in adolescents, compared with a matched cohort of adolescents on nonsurgical lifestyle treatment identified from the Swedish Childhood Obesity Treatment Register (BORIS).
The study group consisted of 85 participants (67% females), aged 16.5 (±1.2) years, with BMI 45.5 (±6.0) kg/m-2 undergoing RYGB. The control group consisted of 62 adolescents (58% girls) aged 15.6 (±1.4) years, with BMI 40.2 (±6.6) kg/m-2. Adolescents in the control group were younger and had lower baseline BMI (p<0.001).
The researchers revealed that dietary assessment/eating-related problem assessments were completed in 98%/95% of the RYGB adolescents at baseline, 93%/98% at one year, 87%/87% at two years and 75%/88% at five years, and in 65%/65% of the adolescent controls at five years.
Outcomes
At five-years, energy intake was lower in RYGB adolescents vs the control group. The relative BMI change (%) was associated with energy intake expressed as total daily energy intake (kcal/day) (p=0.001) or energy intake per ideal body weight (p<0.001). Although, there was no significant association between BMI change (%) and energy intake when analysing RYGB and control groups separately.
At five-years:
RYGB adolescents reported reduced intake of cooked meals and milk and yoghurt while alcoholic drinks and coffee and tea were increased (p<0.05, for all)
RYGB adolescents reported a lower intake of cooked meals, milk and yoghurt, and sugary drinks and a higher intake of coffee and tea compared with controls
RYGB adolescents reported consuming sugary drinks 55% versus 80% in the controls (p=0.006
RYGB portion size of dinner was reduced, and both lunch and dinner was smaller compared with controls
In addition, the proportion of adolescents screening positive for binge eating (BES-score >17) was lower than before surgery (12% vs. 37%, p=0.010) and lower than in controls at five years (30%, p=0.050). Screening positive for binge eating or not before surgery did not predict differences in any of the weight or dietary intake parameters after surgery (p>0.2, for all).
The authors summarised that this study revealed that the dietary composition behind the differences in energy intake between surgically treated adolescents and controls is mainly driven by less milk and yoghurt, sugary drinks, and smaller portions of cooked meals at lunch and dinner. They also noted that in RYGB adolescents there was a weak association between binge-eating and energy intake post-surgery, but this association was much stronger in controls, therefore loss of control is more important than the amount of food consumed post-surgery to identify eating-related problems.
“Long-term changes in dietary intake after RYGB in adolescents feature reduced energy intake, portion size of cooked meals at dinner, and milk and yoghurt, and increased intake of alcoholic drinks and coffee,” the authors concluded. “Associations between self-reported energy intake and eating-related problems appear to be weak after surgery. Adolescents who experience eating-related problems should be studied regarding whether dietary and psychological interventions lead to a better outcome.”
Further information
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