Inpatient Weight Loss As a Precursor to Bariatric Surgery for Adolescents With Extreme Obesity

Evan P Nadler, MD, Faisal G Qureshi, MD, Leah C Barefoot, MSN CPNP, Daniel Davidow, MD. Children’s National Medical Center, Cumberland Hospital for Children and Adolescents


Background: As the obesity epidemic continues to take its toll on both the patients who are stricken with the disease and our healthcare system debate continues regarding the optimal utilization of weight loss surgery and its long-term consequences, especially for adolescents. One subset of patients where the controversy may be even more pronounced is adolescents with massive or extreme obesity (BMI>60), as risk of complications in this wieght category is higher than for others undergoing bariatric surgery. Several strategies have been suggested for this patient group including staged-operations, combined operations, intragastric balloon use, and endoluminal sleeve placement. However the device options are often not available to adolescents, and there are no data regarding staged or combined procedures in this age group. Here we report 3 adolescents who underwent inpatient weight loss followed by laparoscopic sleeve gastrectomy.
Methods: All adolescents with BMI>60 who were referred to our program were evaluated for inpatient medical weight loss prior to laparoscopic sleeve gastrectomy. The medical weight loss program utilizes a multidisciplinary approach with a protein sparing-modified fast diet, exercise, and behavioral modification as its pillars.  Three such patients have copmpleted pre-operative medical weight loss at a sub-acute facility and subsequently undergone laparoscopic sleeve gastrectomy at our insitution.
Results: Two African-American males and one African-American female were referred to our surgical weight loss program with BMI >60. All 3 patients were 18 years of age at the time of referral. The first male weighed 197 kg with a BMI of 62. His pre-operative weight loss was 16kg (13% Excess Weight Loss or EWL) and post-operative weight loss now 18 months after surgery is an additional 50kg (46% EWL) for a total weight loss of 66kg (59% EWL). The second male weighed 220 kg with a BMI of 61. His pre-operative weight loss was 33kg (24% EWL) and post-operative weight loss now 6 months after surgery is an additional 24kg (23% EWL) for a total weight loss of 57kg (47% EWL). The female patient weighed 238 kg with a BMI of 96. Her pre-operative weight loss was 56kg (31% EWL) and post-operative weight loss now 9 months after surgery is an additional 17kg (14% EWL) for a total weight loss of 73kg (45% EWL). The BMI for each patient at their most recent follow up was 41, 45, and 62 respectively.  No complications occurred at any point in their care.
Conclusions: Pre-surgical weight loss via an inpatient program for adolescents with a BMI>60 results in total weight loss comparable to a primary surgical procedure alone, with the benefit of decreasing the peri-operative risk. We recommend this practice as an ideal algorithm for adolescents suffering from extreme obesity.

Session Number: Poster – Poster Presentations
Program Number: P460
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