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Published in final edited form as: Surg Obes Relat Dis. 2024 Sep 14;21(1):16–23. doi: 10.1016/j.soard.2024.09.003

Psychosocial Outcomes after Adolescent Metabolic and Bariatric Surgery: A Narrative Review of the Literature

Richard E Boles 1, Jaime M Moore 2
PMCID: PMC11645231  NIHMSID: NIHMS2024363  PMID: 39379258

Abstract

The prevalence of severe obesity among adolescents continues to be a significant global concern. Metabolic and Bariatric Surgery (MBS) has increasingly shown to produce safe, efficacious, and durable effects on weight loss and related physical health complications, and evidence of psychosocial outcomes are beginning to mature. The revised American Society for Metabolic and Bariatric Surgery pediatric guidelines published in 2018 reported emergent data regarding key psychosocial outcomes, including mental health, disordered eating, and quality of life, though data were limited by small, short-term studies and often without comparison groups. The purpose of this narrative review was to expand the relevant findings regarding youth with severe obesity who receive MBS to further clarify the impact of surgery on psychosocial outcomes.

Keywords: adolescent bariatric surgery, psychosocial, quality of life, outcomes

Introduction

The global prevalence of obesity during adolescence has continued to rise, and within the US, approximately 9% of adolescents meet criteria for severe obesity, defined as sex and age normed body mass index ≥ 1.2 times the 95th percentile or ≥ 35 kg/m2.1–4 Adolescents with severe obesity have a multitude of physical health risks, including type 2 diabetes, steatotic liver disease, dyslipidemia, and hypertension.5 Lifestyle-focused and behavioral-only interventions have been marginally effective at reducing severe obesity.6 Adjunct obesity-modifying medications are progressively being developed, have demonstrated efficacy, and are increasingly considered viable options for patients without contraindications; however, access remains a significant barrier, and health improvements for most depend on chronic, lifelong use.7, 8 The only intervention with evidence of long-term safety and efficacy, including improvement in life expectancy, is metabolic and bariatric surgery (MBS).6 While the pediatric long-term health outcomes for adolescent MBS remain relatively limited compared to outcomes after adult MBS, high-quality pediatric data have begun to mature, specifying evidence for safety, the magnitude of weight loss, and remission of medical comorbidities beyond 1–2 years.9–13

The relationship between severe obesity and psychosocial functioning

Adult studies have shown notably higher rates of psychiatric comorbidities among those seeking MBS when compared to general population estimates of adult psychopathology.14, 15 For instance, the Longitudinal Assessment of Bariatric Surgery (LABS-3 Psychosocial Study) reported psychopathology preoperative estimates (n=199) ranging from 33.7% with one or more current Axis I (i.e., mental health and substance use) disorders to 68.8% when reporting lifetime history of any disorder, including major depressive disorder (38.7%), any anxiety disorder (31.7%), binge eating disorder (13.1%), bulimia nervosa (2.5%), and alcohol use or dependence (33.2%).15

Similar to the LABS study, the Teen-LABS study is a multi-center, prospective observational cohort study of 242 adolescents with severe obesity and participants were evaluated for preoperative rates of psychiatric symptoms. Utilizing a prospective, ancillary study comparison group of non-surgical adolescents with severe obesity (TeenView), rates of psychopathology were largely similar between the surgical Teen-LABS and TeenView groups (i.e., p > .05). Specifically, the prevalence of elevated Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) scales for the surgical group included somatic symptoms (i.e., extreme focus on physical symptoms) (18.0%), affective disorders (e.g., Major depressive disorder) (22.3%), anxiety (7.2%), attention deficit/hyperactivity disorder (ADHD) (9.4%), oppositional defiant disorder (ODD) (10.8%), conduct disorder (6.5%), obsessive-compulsive disorder (7.2%), or post-traumatic stress disorder (9.4%).16 Additionally, there were no significant differences between these two groups for reported current use of outpatient mental health treatment, psychiatric medication, or psychiatric hospital admissions (25.5%, 19%, 3.6%, respectively for the surgical group).16 Unlike in adults, rates of adolescent psychopathology in both the surgical and non-surgical groups were collectively similar to national rates among adolescents in the general public. However, specific subsets of patients seeking surgery at baseline who have either eating disorders, family dysfunction, or who were receiving lifestyle interventions have been shown to have greater risk for psychopathology.16 Though not statistically different, a notable observation was that adolescent surgical candidates had a consistently lower prevalence of psychopathology compared to lifestyle-seeking adolescents with severe obesity. This may be related to the more intensive mental health support integrated into the preoperative process, which may reduce the frequency of individuals with more significantly impaired mental health. Thus, adolescents with severe obesity, regardless of seeking surgery or lifestyle interventions showed similar rates of psychiatric concerns compared to national samples at that time of study, which was between 2001 and 2004.17 The overall relationship between psychopathology and body weight has shown, however, that in general, more mental health symptoms are present as body weight increases. For instance, in a 2020 systematic review and meta-analysis, Rao and colleagues showed that children and adolescents with overweight and obesity were at significantly higher risk for clinical depression compared to participants with healthy weight.18

Metabolic and Bariatric Surgery and Psychosocial Outcomes

Given the nuanced relationship between adolescents with severe obesity and psychosocial function, a key area of scientific inquiry is aimed at collecting evidence to characterize effects of MBS on psychosocial outcomes and in relation to weight and other health outcomes. Such evidence could refine clinical practice recommendations and specific guidelines for the evaluation and management of adolescents with severe obesity considering MBS.8, 19 In 2018, the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee updated their evidence-based guidelines from 2012 to reflect the proliferation of data and further reduce the stigma of obesity and consideration of MBS as a treatment option.19 Psychosocial risks and outcomes included three key areas: (1) mental health (internalizing e.g. depression/anxiety, externalizing e.g., ADHD, ODD disorders, and suicidal behaviors), (2) disordered eating, and (3) quality of life. Additional contextual factors that may affect risks were also reviewed (i.e., family functioning, child maltreatment, and substance use behaviors) but are not included in this review due to limited scope.

As the field of adolescent MBS continues to evolve with 6 years since the last ASMBS published guidelines, psychosocial outcomes are becoming further elucidated with new and ongoing rigorous studies, collectively on a global scale.11, 12, 20–24 These studies, in addition to numerous smaller, yet credible reports are beginning to further define psychosocial outcomes. The purpose of this narrative review is to summarize the extant data related to psychosocial outcomes after MBS for adolescents with severe obesity across primary psychosocial domains.

Methods

Studies were selected for this narrative review with a priority on empirical data collected among adolescents and young adults with severe obesity who completed MBS and were measured on one or more psychosocial factors. Studies published within PubMed, PsycINFO, MEDLINE (Ovid), and Web of Science were reviewed in December of 2023 and again in March of 2024. Keywords found within the title and/or abstract included variations and combinations of the following terms: “bariatric surgery”, “sleeve gastrectomy”, “gastric bypass”, “roux-en-Y”, “gastric banding”, “youth”, “child”, “adolescent”, “pediatric”, “mental health”, “psychological”, “psychiatric”, “psychosocial”, “social”, “internalizing”, “externalizing”, “depression”, “anxiety”, “mood”, “suicide”, “eating disorder”, “binge”, “loss of control”, “quality of life”, “health related”, and “weight related”. References from identified articles were also reviewed for inclusion. Studies were further examined when reported changes after bariatric surgery among youth included any of the three domains of interest: (1) mental health focused on internalizing disorders, (2) mental health disorders focused on disordered eating, and (3) quality of life. Study types considered for inclusion were also restricted to those with post-operative measurements and published between 2017 and 2024 to reflect updated findings following the literature cited within 2018 ASMBS Pediatric guidelines 19. Exclusion criteria for updated evidence were (1) non-English reports; (2) study populations with only adult participants; (3) studies with baseline data only and (3) qualitative studies, editorials, book chapters, reviews, case reports/studies, animal studies, and studies completed for education (e.g., dissertations). The search process initially yielded a total of 5257 studies from major key words that were then narrowed based on relevance to the three domains of interest, which yielded 25 articles included in this review (12 for Mental Health; 8 for Disordered Eating; and 5 for Quality of Life).

Mental Health

The understanding of mental health outcomes after adolescent MBS has significantly advanced, strengthening findings from prior studies. Specifically, the addition of comparison groups and/or enrollment of larger samples with longer follow up have provided greater confidence in the outcomes. Mental health outcomes after MBS were largely encouraging with general psychiatric improvement initially described, though rates of improvement were less durable 1 year after surgery.25 Further, evidence from earlier studies also indicated subsets of participants with ongoing or trends of declining mental health, including 14% of adolescents reporting suicidal ideation (SI) at 2-year follow-up and SI being more likely among adolescents reporting poor mental health after MBS.25, 26 Prior evidence incorporated data from large, prospective studies, and found no group level evidence linking mental health problems (before or after MBS) with weight outcomes. However, overall mental health conclusions remained appropriately cautious with limitations including relatively small samples (N sizes ≤ 101), absence of a control group, and a relatively short follow up period (≤ 2 years).25–27

Mackey and colleagues (2018) followed 222 adolescents with severe obesity for one year, with 169 youth receiving MBS while 53 did not complete MBS. At baseline, 71% of participants across both groups were diagnosed with at least 1 mental health disorder with non-significant between-group differences. Total prevalence rates for disorders across both groups were depression (41%), anxiety (26%), ADHD (21%), and an eating disorder (8%), with the biggest non-significant difference being greater prevalence of an eating disorder for the group that did not complete MBS (14% for non-MBS vs. 6% MBS). While changes in psychiatric diagnoses were not reported in this study, the authors reported no relationship between preoperative diagnoses (specifically or cumulatively) and 1 year weight loss outcomes.28 Similarly, Baskaran and colleagues evaluated changes in depression and anxiety among adolescents with severe obesity before and 6 months after MBS, including n=15 who completed MBS and 15 participants who did not. There were no differences between groups at baseline or follow-up for rates of depression, anxiety, or suicidal ideation. Additionally, despite significant weight loss for those after MBS, mental health symptoms were not improved.29

Investigators studying larger cohorts of adolescents have extended mental health outcomes after MBS in comparison to a matched control group of adolescents with severe obesity not seeking MBS at 2- and 4-year intervals. The Teen-LABS study group showed that from baseline to 2 years after MBS, mental health status (symptomatic or nonsymptomatic) after MBS (n=139) and the TeenVIEW control group (n=83) was generally unchanged, and not predictive of weight loss.30 These findings were supported by other 2-year follow up findings showing no change in depression or anxiety despite weight loss.31 Important predictors of 2-year psychopathology was, however, related to baseline mental health problems in addition to other key correlates, including disordered eating (loss of control) and substance use.30 An additional 2-year maintenance period of psychosocial outcomes (baseline to year 4) was examined with Teen-LABS and TeenVIEW and results further supported the conclusion that psychopathology status, particularly internalizing symptoms, was unchanged over time (now out to 4 years) and not linked with receiving MBS, experiencing significant weight loss, or later weight regain.32 With specific attention to suicidal thoughts and behaviors, Zeller and colleagues also reported 4-year follow-up between Teen-LABS and TeenVIEW participants. Findings showed that suicide risks were similar to normative national rates and not increased or decreased between groups who either lost clinically significant weight (MBS group) or gradually continued to gain weight (control group).33 There was notable emergence of increased suicide risks for those with poorer mental health functioning in this study (specifically depressive symptoms, externalizing symptoms, and loss of control eating; with odds ratios of 1.09, 1.07, and 4.90, respectively) and by other reports using similar methods.34 Thus, suicidal risk remains critical to study and mitigate for patients considering MBS.33

In addition to larger samples, mental health outcomes with longer postoperative follow up (greater than 4 years) and methodologically rigorous, randomized control trials (RCTs) have also begun to more recently characterize long-term trajectories.12, 20, 22, 35 The Adolescent Morbid Obesity Surgery (AMOS) study examined Swedish youth (ages 13–18 years) with severe obesity receiving MBS (n=81) compared to a non-randomized, matched control group with severe obesity (n=80) and the AMOS 2 study utilized a RCT design. In AMOS, Jarvholm and colleagues compared objective Swedish national register data on prescribed psychiatric medication and inpatient/outpatient mental health diagnostic codes before and 5 years after MBS. While the prevalence of psychiatric medications and diagnoses generally increased over time, before and 5 years after surgery, there were no between-group differences. Additionally, rates of diagnoses while receiving mental health care were similar across groups at baseline where the most common conditions being treated were activity and attention disturbances, anxiety, and depressive concerns. Although baseline engagement with mental health therapy was similar across groups at baseline, participants who received MBS were more likely to receive psychiatric treatment (i.e., inpatient, outpatient, and medication use) during the 5 years compared to the control group who also increased psychiatric treatment use but to a lesser extent.21 Specific inventories of depression (Beck Depression Inventory-2) and anxiety (Beck Anxiety Inventory) from participants in AMOS showed no significant changes over the same 5 year period; suicidal ideation (SI) was reported by 16% of the sample at 5 years, and adolescents with SI lost significantly less weight than those without reported SI.22 The AMOS2 study randomized 50 adolescents with severe obesity (25 to MBS and 25 to non-surgical treatment) and followed for 2 years. From baseline to one-year, mental health status for participants randomized to receive MBS was shown to improve, while those in the non-surgical group were unchanged or declined. By year 2, however, mental health was not significantly different between the two groups, though more participants after surgery reported SI (n=4) compared to the control group (n=1).12

Other studies with long-term post adolescent MBS follow up (≥ 10 years), indicate that psychiatric diagnoses and related psychotropic medication use for youth after MBS (n=1554) increased at a faster rate when compared to a non-overweight comparison group (n=15,540), matched on age, sex, and location (but not weight status).20 In contrast, de la Cruz-Munoz and colleagues contacted 96 individuals who had surgery before age 21 and found mixed improvement for mental health comorbidities (depression, but not anxiety) though data were not compared to a control group.35 Collectively, current evidence from these ongoing studies reinforce clinical recommendations to identify patients during the initial evaluation at pediatric MBS programs for mental health concerns for management before and after surgery and possible increased post-operative mental health risks including SI, and that expectations for psychiatric improvements should be relatively independent of weight loss and medical comorbidity resolution.

Disordered Eating

Binge eating disorder (BED) and loss of control (LOC) are the two disordered eating patterns that have been most often linked with youth who have overweight or obesity.36 The DSM-5 defines binge eating as an episode that includes eating an unusually large amount of food during a short duration of time and having a sense of loss of control with associated features, such as feelings of shame or guilt. The feeling of being unable to stop eating (LOC), regardless of amount consumed, has been suggested as the critical component of BED.37 Prevalence estimates for disordered eating behaviors identified among youth in the Teen-LABS cohort at baseline (n=242) included LOC eating (27%), followed by BED, ranging from ~7% to 15.4%, depending on the definition of “marked distress” related to binge eating.38, 39, night eating syndrome (5%), and bulimia nervosa (1%). Similar to non-surgical samples.16, individuals seeking MBS with LOC also have more significant mental health concerns (e.g., depression and lower weight-related quality of life).38

The evaluation of disordered eating behaviors among adolescents after MBS with larger samples and control groups first appeared for 1 to 2-year follow-up time points among previously discussed Teen-LABS and AMOS datasets. Two reports from Teen-LABS, utilizing two different non-surgical control groups (n sizes from 83 to 169) and adolescents receiving MBS (n sizes from 119 to 139), examined disordered eating using validated measures of eating pathology.30, 40 Results at baseline indicated participants in the MBS group vs. the control group, reported significantly more symptoms of disordered eating, including a global score and subscales for restraint, shape and weight concerns, hunger, and night eating behaviors. Compared to youth in a lifestyle comparison group, 6 and 12-months after surgery, youth after MBS reported significantly fewer symptoms of disordered eating (globally, and for restraint, shape, and weight concerns).40 When extended out to 2 years, baseline report of LOC for both surgical and non-surgical participants was predictive of postoperative psychosocial impairment.30 Similarly, 82 adolescents from the AMOS study were followed for 2 years after surgery. Baseline prevalence of moderate or higher Binge Eating Scale (BES) scores was 37% and was associated with more baseline mental health problems. After surgery, BES scores were significantly lower at 1 year (5%) and 2 years (10%) after MBS. In addition, there were significant reductions in uncontrolled eating and emotional eating, though elevated baseline BES scores were associated with greater reported SI at 2 years. There was no relationship between BE or other disordered eating at baseline and weight loss at 1 year. However, 2 years after surgery, disordered eating behaviors, BE, emotional eating, and uncontrolled eating demonstrated associations with reduced weight loss.41 Overall, short-term ( <2 years) follow up reveals some improvement in disordered eating, but individuals with post-operative disordered eating may experience less favorable weight loss.

When further followed out to 4 years after MBS, youth enrolled in Teen-LABS (n=234) were examined on rates of LOC across two phenotypes - consuming either a very large amount of food or continuously eating regardless of the amount of food. Before surgery, 10.1% of participants endorsed both types of LOC, with percentages for both at 6-months post (0.5%) and 4 years later (2.1%) being significantly lower. Similar trends were observed for the presence of only one type of LOC (either large amounts or continuous eating), in which significant drops occurred at 6 months with gradual increases through 4 years postoperatively.42 Notably, however, the increase over time for continuous loss of control eating was steeper from 6 months through four years compared to loss of control during eating for large amounts of food. In contrast to earlier adolescent data,27 preoperative LOC had no relation with weight loss after surgery.42 However, LOC after surgery, particularly after 1 year (manifesting more as grazing behaviors vs large binge eating episodes) was significantly predictive of poorer weight loss out to 4 years.42

Evidence of disordered eating from baseline to 5 years after surgery among participants (n=81) in the AMOS study showed similar patterns to the Teen-LABS outcomes, in which BE and uncontrolled eating were significantly lower after surgery at 1 year, but gradually increased over 5 years and baseline disordered eating behaviors were not associated with 5 year weight loss outcomes.21 In contrast, LOC reported by participants after surgery was not related to poorer weight loss over time, which may be explained by a smaller sample or differences in how loss of control was assessed.21, 42

Most recently, Teen-LABS investigators further extended disordered eating outcomes to 6 years in which unexpected results showed that LOC was related to improvement in low- and high-density lipoprotein cholesterol levels and aside from back pain, not with other health problems (e.g., A1C, elevated blood pressure, hyperlipidemia, gastrointestinal complaints, PCOS). MBS appeared to show durable health outcomes, even though LOC and related weight gain may occur.23 Finally, Decker and colleagues also examined 6-year disordered eating outcomes among the Teen-LABS cohort in comparison to the TeenVIEW non-surgical control group. Participants in TeenVIEW showed increased problematic eating behaviors (e.g., large volume binge eating, grazing) compared to those who received MBS and that problematic eating behaviors among both groups were associated with poor weight outcomes at year 6.43 Consistently across these latest studies, evidence shows that disordered eating is associated with poor psychosocial functioning and weight outcomes across youth with severe obesity, though disordered eating may not diminish key physical health related improvements for those who undergo MBS.

Quality of Life

Youth with severe obesity experience significantly reduced quality of life (QoL). This includes lower overall and weight-specific QoL as well as QoL related specifically to physical health, psychosocial health, physical comfort, body esteem, and social and family life. Additional methodological advancement utilizing larger, multisite data from the Teen-LABS cohort in addition to the TeenVIEW non-surgical adolescent control group with severe obesity, has provided strength in outcomes related to the impact of MBS on QoL. Consistent with prior reports, Reiter-Purtill and colleagues found significant improvement in health- and weight-related QoL among those who received MBS compared to the control group and most strongly during the first year after surgery, which tapered during year 2. Of note, this improvement did not include the mental component for health related QoL at 1 and 2 years.44 Further, the mental health related QoL (measured at baseline, 6-, 12-, and 24 months) was inversely associated with symptoms of internalization and LOC eating, both of which were measured at baseline and 24 months. Similar findings across multiple other studies with follow-up extended to 5 years after surgery, in which adolescents and young adults (ages 18–25 years) showed mainly improvement in physical quality of life and much less with mental QoL.45–48 In sum, low quality of life for youth with severe obesity strongly improves following MBS, but appear to be primarily related to physical health QoL factors.

Limitations

As with any study, this review has limitations. First, this updated review of psychosocial outcomes after adolescent MBS did not include contextual risk factors such as family functioning, child maltreatment, or substance use behaviors), which were considered beyond the scope of this review. Second, additional psychosocial factors related to special populations that include preadolescents, youth with intellectual and developmental disorders, genetic syndromes, and physical disability were not included. Finally, there may have been additional articles not discovered and included in this review, potentially biasing the conclusions.

Conclusions

The proliferation of studies reporting psychosocial outcomes after MBS for youth with severe obesity has been instrumental in further clarifying risks and expected improvements over longer periods of postoperative time. Specifically, the preponderance of evidence indicates that youth with severe obesity who present for MBS and those receiving lifestyle interventions have associated risk for mental health impairments, disordered eating, and reduced health and weight related quality of life. Aside from active psychosis, suicidality, or substance abuse, these baseline psychosocial impairments continue to be non-contraindications for MBS. Moreover, despite impressive changes in weight and comorbidity improvements, mental health functioning before surgery is likely to remain unchanged after surgery. Given these findings, engagement in therapy is recommended throughout the entire pre- and postoperative MBS course among adolescents who have or develop mental health concerns. Suicide risk for youth after MBS remains critical to monitor and may be particularly high for individuals who have shown less favorable weight loss and/or who struggle with mental health, postoperatively. We acknowledge that holistically, the state of adolescent mental health remains seriously challenged and these challenges were exacerbated by the COVID-19 pandemic.49 As a result, the rising mental health needs of youth, and particularly those with severe obesity, including those who present for MBS, require ongoing assessment and treatment for mental health concerns. MBS centers with staffed mental health providers to screen for mental health symptoms during monthly visits will be well positioned to follow up for more intensive assessment and referral of services, when indicated.

A key question remains unanswered regarding the preoperative management of patients who present with active endorsement of suicidal ideation or actively engage in self-harm behaviors. Clinical recommendations have suggested minimum periods of stability of no less than 1 year though the timing has not been evaluated empirically from a clinical context and in particular with adolescent bariatric surgery candidates. There are a significant number of factors that make each case unique, which include the nature of mental health hospitalization, exposure to stressors and protective factors, and access to care including adequate oversight from a mental health provider who has the ability to provide ongoing support after surgery. No studies have yet clarified best practice related to delaying surgery when SI occurs. And, given the ethical challenges, MBS programs are likely best positioned to treat each case individually, with interdisciplinary input including psychology, opposed to using an arbitrary standard timeline.

While disordered eating before surgery has not been linked with postoperative weight outcomes, BE and LOC have been shown to improve after surgery, these problematic eating behaviors after surgery are linked with less favorable weight loss, generally after 1 year or later. Disordered eating concerns after surgery have been shown to be increasingly concerning, with 4-year recurrence rates of up to 25%-37% for LOC, though this may be a conservative estimate, given systematic assessment is limited and long term follow up is difficult to achieve.43 Standardized assessment for disordered eating by a mental health provider at baseline and referral for eating behavior concerns remains a recommended practice before and surgery. In addition, evidence now supports long-term standardized monitoring of post-operative eating behaviors, particularly after 6–12 months.

Preoperative disordered eating behaviors showed predictive risks for mental health concerns after surgery which may be best addressed with family-based approaches, such as interpersonal psychotherapy which helps to improve communication, strengthen parent-child relationships, and improve interpersonal problems to reduce problematic eating behaviors such as LOC-eating.50 Additionally, evidence supports cognitive behavior therapy and family-based interventions for treating eating disorders.51 Evidence on such interventions among youth considering bariatric surgery remain scarce, however, and the timing both before and after surgery remain unclear for optimal outcomes at this time.

Future studies with adolescents considering MBS will benefit from continuing to address limitations related to sample size and length of follow up while developing and testing interventions to improve recalcitrant, recurrent, or emergent post-operative mood, eating disorder, and quality of life concerns, even if in the setting of significant weight loss and improved physical health. The clinical implications (summarized in Table 1) are clear that pediatric mental health providers remain crucial during initial MBS assessment, preoperative preparation, and during postoperative follow-up contacts to monitor and manage psychosocial concerns.

Table 1.

Summary of psychosocial outcomes for adolescents after MBS

Evidence-based Outcomes Clinical Implications
Mental Health • Pre-existing mental health impairments may persist throughout pre- and post-operative periods, independent of weight loss.
• Adolescents who have baseline risks including disordered eating and substance abuse appear to be at greater risk for post-operative mental health problems, including suicidal ideation.		 • Early (1st visit) and ongoing evaluations during all follow up visits using validated measures for mental health (e.g., depression, SI, substance use) remain critical to identify and address problems that persist, recur, or develop over time.
Eating Disorders • Binge eating and loss of control (LOC) improve for many youth initially after surgery, but prevalence increases particularly 2 years or later postop.
• Disordered eating is a risk factor for mental health problems and SI after surgery.
• LOC eating after surgery has been linked with less weight loss, though physical health improvements may be sustained.		 • Early (1st visit) and post-operative evaluations (>1 year) using validated instruments for disordered eating remain critical to complete to identify those at greater risk for post-operative weight regain and psychosocial risks
Quality of Life • Quality of life is low for youth before surgery.
• Physical, but not mental health QOL improves during 1st year.		 • Quality of Life assessments, with attention to all sub-scales, remain an important pre/post op tool.
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Supported by:

JMM was supported by NIH Career Development Award (K23HL163480)

Footnotes

Disclosures:

REB: None to declare

JMM: None to declare

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Contributor Information

Richard E. Boles, Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.

Jaime M. Moore, Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.

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