Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery

Jennifer Reiter-Purtill, Sanita Ley, Katherine M Kidwell, Carmen Mikhail, Heather Austin, Eileen Chaves, Dana L Rofey, Todd M Jenkins, Thomas H Inge, Meg H Zeller, in cooperation with the TeenView Study Group and Teen-LABS Consortium, Jennifer Reiter-Purtill, Sanita Ley, Katherine M Kidwell, Carmen Mikhail, Heather Austin, Eileen Chaves, Dana L Rofey, Todd M Jenkins, Thomas H Inge, Meg H Zeller, in cooperation with the TeenView Study Group and Teen-LABS Consortium

Abstract

Background/objectives: Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient-reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a nonsurgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes.

Subjects/methods: Multi-site data from 139 adolescents undergoing bariatric surgery (Mage = 16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI] = 51.5 kg/m2) and 83 comparators (Mage = 16.1; 81.9 % female, 54.2% White; MBMI = 46.9 kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes.

Results: Significant improvement in WRQOL and Physical HRQOL, particularly in the first postoperative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had significantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were significantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating.

Conclusions: For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early postoperatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Conflict of interest statement

Competing Interest Statement: Thomas H. Inge has served as a consultant for Zafgen Corporation, Biomedical Insights, and L&E Research, and received honoraria from Standard Bariatrics, UpToDate, and Independent Medical Expert Consulting Services, all unrelated to this project. All other authors declare no potential competing interests.

Figures

Figure 1.
Figure 1.
TeenView participant recruitment and retention.
Figure 2.
Figure 2.
Change in total weight-related quality of life (WRQOL), physical health-related quality of life (HRQOL), and mental health-related quality of life over time. Note: The Total score of the Impact of Weight on Quality of Life-Kids (IWQOL-Kids) was created by transforming raw scores to a 0–100 scale, with higher scores representing better total WRQOL. The Physical Component Summary (Physical HRQOL) and Mental Component Summary (Mental HRQOL) of the Short Form-36 (SF-36) are norm-based, standardized scores based on the general population of the United States with a mean of 50 and a standard deviation of 10. The y-axes of the graphs above are adjusted accordingly. Expected means (2A.1, 2B.1, 2C.1) were plotted from longitudinal analyses within a structural equation modeling framework for each outcome over time for surgical patients (Surg) and non-surgical comparators (Comp). Observed means (2A.2, 2B.2, 2C.2) for each outcome are plotted over time for surgical patients classified by BMI group at 24 months and comparators. BMI classifications were healthy (BMI=18.5–24.9, n=6), overweight (BMI=25.0–29.9, n=25), Class I obesity (BMI=30.0–34.9, n=37), Class II obesity (BMI=35.0–39.9, n=24), and Class III obesity (BMI≥40.0, n=30).

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