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Characteristics of weight regain following sleeve gastrectomy in an adolescent bariatric program

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Characteristics of weight regain following sleeve gastrectomy in an adolescent bariatric program
Astrid R. Soares-Medina, Marnie Walston, Jenny Xu, Ihouma Eneli, Marc P. Michalsky
Nationwide Children´s Hospital. Columbus, Ohio.

AIM: Although weight regain (WR) has been observed after bariatric surgery in both adults and adolescents, there is a relative paucity of data related to WR in the adolescent population. The aim of this study is examine characteristics and patterns of WR among a cohort of adolescents following vertical sleeve gastrectomy (VSG). 
METHODS: A retrospective analysis of adolescents and young adults who underwent VSG at a single pediatric tertiary care facility with a minimum follow-up of 24 months was performed (January 2010 and March 2015). Data related to demographic variables, comorbidities, height, weight and BMI were collected from baseline visits (within 30 days prior to bariatric surgery) and routine post-operative visits.  For subjects lost to follow-up to the bariatric clinic, corresponding anthropomorphic data were abstracted from the electronic medical record when available from non-bariatric clinical encounters within our institution. WR was defined as ≥ 15% increase in weight  from post-operative total body weight nadir. Statistical analysis was performed using ANOVA and Chi square test.
RESULTS: Forty-four subjects undergoing VSG, consisting of mostly females (86.4%) with a median age of 17.5 years, with ≥ 24 months of follow-up data (range 24.1 to 76.8 months) were included in the analysis. WR was observed in 34% (15/44); mostly females (14/15) with a median 16.8 years at time of surgery. Conversely, 66% (29/44) has no WR,  and a median pre-operative age of 17.4 years. Multiplicity of comorbid disease (≥2) was observed in 73% (11/15) of individuals in the WR group versus 65.5% (19/29) in the No-WR group. There was no difference in the preoperative work-up duration (9.3 months WR vs. 11.1 months no-WR). Significant and ongoing differences in median weight reduction between groups (WR vs. no-WR) were first detected as early as 1 year (-33.1% vs. -24.3% respectively, p=0.01) and resulted in diverging post-operative weight loss trajectories (Figure 1).
DISCUSSION: Similar to adults, WR after bariatric surgery is seen in a subset of adolescents. The median weight reduction after VSG is significantly more pronounced among individuals that demonstrate no WR at 1 year compared to those with  who experience early weight regain. The median time for initiation of WR at 12 months suggests a period of potential vulnerability and opportunity. Future investigations designed to identify variables responsible for post-operative WR in the context of multidisciplinary care are needed.
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