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）具有侵入性且伴随风险，但可帮助极重度肥胖青少年实现持续减重，并带来显著健康获益。目前针对该群体是否选择MBS的知情决策路径尚缺乏充分描述，且术后风险与获益评估的随访方案也缺乏统一性。本研究针对极重度肥胖青少年，旨在评估其针对MBS的决策情况，同时在结构化的MBS术前及术后管理框架下，分析MBS的转归、随访依从性及对医嘱的遵循情况。
方法：研究对象招募自多中心项目「极重度肥胖青少年研究（Youth with Extreme Obesity Study, YES）」。该研究是一项针对14~24岁肥胖青少年及年轻成人的队列研究，纳入标准为体质指数（Body Mass Index, BMI）≥30.0 kg/m²，于2012-2018年间在德国的4家医疗中心及1家就业服务中心完成招募。本研究的亚组3纳入来自2家医疗中心、符合BMI≥35kg/m²、年龄14~24岁且有意向接受MBS的受试者，其研究标题为「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」，该亚组包含为期2个月的术前准备及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人（17%）有意向接受MBS。其中26人符合已发表的MBS入组标准，并参与了结构化术前准备项目。在这26人中，9名受试者（2名女性）选择放弃MBS，17人（n=11名女性）选择接受MBS，术式为袖状胃切除术（sleeve gastrectomy）。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降低（BMI变化量：-16.1±5.6 kg/m²）。术后第一年，16名受试者中有11人（69%）遵医嘱服用膳食补充剂，但其中仅5人（31%）每日规律服用。与较高的12个月留存率形成对比的是，结构化项目结束后的远期随访率较低：24个月随访时为9/16（56%），36个月随访时为5/15（36%）。
结论：受试者展现出针对MBS的主动决策能力，且对结构化术前及术后12个月管理项目的依从性较高，但后续随访参与度显著降低。本研究结果提示，亟需建立长期结构化的MBS术后管理方案，以追踪该群体的远期转归，并为这一处于向成年过渡期的脆弱人群提供充足的医疗照护。