Supplementary Material for: Twelve-months outcomes after metabolic and bariatric surgery among youths participating in a structured preparation and follow-up program – Results of the Youth with Extreme obesity Study (YES)

Introduction: While invasive and associated with risks, metabolic and bariatric surgery (MBS) can promote sustained weight loss and substantial health benefits in youths with extreme obesity.The path toward informed decision making for or against MBS is poorly characterized and postoperative follow-up to assess risks and benefits is inconsistent. In youths with extreme obesity we aimed to evaluate decision making toward MBS, as well as MBS outcomes and adherence with follow-up and recommendations in the setting of a structured pre- and post- MBS.
Methods: Participants were recruited in the setting of the multicenter “Youth with Extreme Obesity Study” (YES). YES is a cohort study in adolescents and young adults aged 14–24 years with obesity (BMI≥30.0 kg/m2) who were recruited at four medical centers and one job center in Germany between 2012 and 2018. Participants at two medical centers with BMI≥35kg/m2, aged 14-24 years, and interested in pursuing MBS were included in the subproject 3 “Safety and effectiveness of weight loss surgery in adolescents with severe obesity within a structured pre- and post-surgery treatment program – an observational study” that comprised a 2-months pre- and 12-months post-MBS program.
Results: Twenty-eight of 169 youths (17%) with BMI≥35kg/m2 were interested in MBS. Twenty-six fulfilled published eligibility criteria for MBS and participated in the structured pre- MBS preparation program. Of these, 9 participants (2 female) decided against, and 17 (n=11 females) decided for MBS (sleeve gastrectomy). The 12-months follow-up rate was high (16/17 [94%]) and all participants achieved significant weight reduction (ΔBMI:-16.1±5.6 kg/m2). Eleven of 16 participants (69%) reported taking the prescribed dietary supplements in the first year after MBS, but only five of them (31%) did so daily. In contrast to the high 12-month retention rate, follow-up after completion of the structured program was low at 24-months (9/16 [56%]) and at 36-months (5/15 [36%]) respectively.
Conclusion: Participants demonstrated active decision making for or against MBS and high adherence with the structured pre- and 12 months post- MBS program, but participation was low thereafter. These findings endorse the need for longer-term structured post-MBS programs to capture long-term outcomes and provide adequate care in this vulnerable group at the transition to adulthood.

引言：尽管代谢减重手术（metabolic and bariatric surgery, MBS）具有侵入性且伴随相关风险，但可帮助重度肥胖青少年实现持续体重减轻并获得显著健康获益。目前，针对是否接受MBS的知情决策路径尚未被充分阐明，且用于评估风险与获益的术后随访方案亦缺乏统一标准。本研究针对重度肥胖青少年，旨在结构化的MBS术前与术后管理框架下，评估其针对MBS的决策情况，同时分析MBS的转归以及受试者对随访与医嘱的依从性。
方法：研究对象招募自多中心「重度肥胖青少年研究（Youth with Extreme Obesity Study, YES）」。该队列研究于2012至2018年间在德国4家医疗中心及1家就业服务中心开展，纳入年龄14~24岁、体重指数（Body Mass Index, BMI）≥30.0 kg/m²的肥胖青少年与年轻成人。其中，来自2家医疗中心、BMI≥35kg/m²、年龄14~24岁且有意向接受MBS的受试者被纳入子课题3「结构化围手术期管理方案下青少年重度肥胖减重手术的安全性与有效性——一项观察性研究」，该子课题包含为期2个月的术前准备与12个月的术后随访管理流程。
结果：169名BMI≥35kg/m²的青少年中，共28名（17%）有意向接受MBS。其中26名符合已发表的MBS入组标准，并参与了结构化的术前准备方案。在这26名受试者中，9名（其中2名为女性）选择放弃MBS，17名（其中11名为女性）选择接受MBS（术式为袖状胃切除术）。术后12个月随访率较高（16/17，94%），所有受试者均实现显著体重减轻（BMI变化量：-16.1±5.6 kg/m²）。16名完成12个月随访的受试者中，11名（69%）在术后第一年遵医嘱服用膳食补充剂，但仅5名（31%）每日规律服用。与较高的12个月随访留存率形成对比的是，结构化方案结束后的随访率较低：术后24个月随访率为56%（9/16），术后36个月随访率为36%（5/15）。
结论：受试者展现出针对MBS的主动决策能力，且对结构化术前方案及术后12个月随访管理的依从性较高，但在此之后的参与率显著下降。本研究结果表明，亟需建立长期结构化的MBS术后管理方案，以追踪该人群的长期转归，并为这群处于向成年期过渡阶段的脆弱群体提供充分的医疗照护。