Obesity
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The aims of the present study were to examine changes in health-related quality of life (HRQOL) and depressive symptoms in adolescents with extreme obesity undergoing Roux-en-Y gastric bypass (RYGBP) across the first postoperative year. A prospective longitudinal observational study of 31 adolescent patients undergoing RYGBP at a pediatric medical center (mean = 16.4 years; 64.5% females, mean BMI 63.5; 97% of study eligible and consecutive patients) was conducted. Participants completed two adolescent HRQOL measures, the PedsQL (generic) and the IWQOL-Kids (weight-related), the Beck Depression Inventory (BDI), and height and weight were measured at three time points: baseline, and 6 and 12 months following RYGBP. ⋯ In contrast, the rate of change in weight-related social relations was linear (e.g., no deceleration), indicating continued improvement across the first postoperative year. Adolescent RYGBP results in significant improvement in HRQOL and depressive symptomatology over the first postoperative year. Longer-term follow-up will be critical to determine adolescent weight and psychosocial trajectories, their interrelations, and what role psychosocial status plays in continued weight loss, maintenance, and regain.
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To reevaluate and update evidence-based best practice recommendations published in 2004 for anesthetic perioperative care and pain management in weight loss surgery (WLS), we performed a systematic search of English-language literature on anesthetic perioperative care and pain management in WLS published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. We identified relevant abstracts by using key words, retrieved full text articles, and stratified the resulting evidence according to systems used in established evidence-based models. We updated prior evidence-based best practice recommendations based upon interim literature. ⋯ A novel application of alpha-2 agonists for perioperative anesthetic care is emerging. Key elements that may enhance patient safety include integration of the latest evidence on WLS, obesity, and collaborative multidisciplinary care into clinical care. However, large gaps remain in the evidence base.
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The objective of this study is to update evidence-based best practice guidelines for psychological evaluation and treatment of weight loss surgery (WLS) patients. We performed a systematic search of English-language literature on WLS and mental health, quality of life, and behavior modification published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. ⋯ From these, we developed evidence-based best practice recommendations on the psychological assessment and treatment of WLS patients. Regular updates of evidence-based recommendations for best practices in psychological care are required to address the impact of mental health on short- and long-term outcomes after WLS. Key factors in patient safety include comprehensive preoperative evaluation, use of appropriate and reliable evaluation instruments, and the development of short- and long-term treatment plans.
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American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. ⋯ The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.