scholarly journals P116 Prophylactic use of enoxaparin during bariatric surgery in adolescents with severe obesity

2019 ◽  
Vol 104 (6) ◽  
pp. e65.3-e66 ◽  
Author(s):  
V Ziesenitz ◽  
J Vaughns ◽  
E Williams ◽  
E Nadler ◽  
G Mikus ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Primary Endpoint ◽  
Severe Obesity ◽  
Peak Plasma ◽  
Surrogate Marker ◽  
Factor Xa ◽  
Post Dose ◽  
Obese Adolescents ◽  
Severely Obese ◽  
Prophylactic Use

BackgroundSevere obesity predisposes adults and youth to a higher risk of venous thromboembolism (VTE). Enoxaparin is frequently used for their VTE management. This study evaluates a BMI-stratified prophylactic dosing regimen of enoxaparin in severely obese adolescents undergoing bariatric surgery.MethodsThis prospective study enrolled severely obese adolescents aged 12–20 years undergoing laparoscopic sleeve gastrectomy. Prophylactic enoxaparin was dosed at 40 mg SC (for a BMI less than 50 kg/m2) and 60 mg SC (for a BMI equal to or greater than or 50 kg/m2). Blood samples were drawn until 12 hrs post-dose. Plasma Anti-Factor Xa (Anti-FXa) activity was used as a surrogate marker for enoxaparin plasma concentration and pharmacokinetics were assessed using non-compartmental PK analysis. The primary efficacy outcome was the anti-FXa activity 4–6 hours after dosing, and the primary endpoint was the proportion of patients who reached prophylactic anti-FXa activity of 0.1–0.3 U/mL between 4–6 hours after dosing.ResultsTen female and two male obese adolescents (age range 14–19 years) had a mean body weight of 140.8 kg (93.7–174 kg) and a mean BMI of 49.9 kg/m2 (38.4–58 kg/m2). Four patients received 40 mg enoxaparin, 8 patients were dosed with 60 mg enoxaparin. No VTE or major bleeding occurred. Peak plasma anti-FXa activity (Cmax) ranged from 0.14–0.30 IU/mL (median Cmax 0.205 IU/mL). Median Tmax was 5.67 hours (range 3.78–7.52 hours). Median AUCi was 1.00 h*IU/mL (range 0.42–1.67 h*IU/mL). 10 out of 12 patients (83%) reached the primary endpoint with anti-FXa activity in the range for VTE prevention (0.1–0.3 IU/mL).ConclusionsIn this single center cohort study, the dosing scheme of 40 mg vs 60 mg enoxaparin stratified according to BMI proved to be effective in reaching prophylactic anti-FXa activity in 83% of adolescent patients. This dosing scheme is in accordance with current practice in adults.Disclosure(s)J. Vaughns and J. van den Anker are supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (5T32HD087969).

Bariatric surgery in severely obese adolescents: a single-centre experience

2014 ◽  
Vol 99 (10) ◽  
pp. 894-898 ◽  
Author(s):  
P. Sachdev ◽  
T. Makaya ◽  
S. S. Marven ◽  
R. Ackroyd ◽  
J. K. Wales ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Single Centre ◽  
Obese Adolescents ◽  
Single Centre Experience ◽  
Severely Obese

scholarly journals Assessment and management of severely obese children and adolescents

2016 ◽  
Vol 101 (12) ◽  
pp. 1161-1167 ◽  
Author(s):  
Neil Wright ◽  
Jerry Wales
Keyword(s):  
Risk Factors ◽  
Bariatric Surgery ◽  
Cardiovascular Risk ◽  
Children And Adolescents ◽  
Cardiovascular Risk Factors ◽  
Severe Obesity ◽  
Therapeutic Interventions ◽  
Obese Children ◽  
Severely Obese ◽  
The Uk

Approximately 3% of children and adolescents in the UK have severe obesity. The incidence of cardiovascular risk factors such as hypertension, hyperinsulinism and hyperlipidaemia approaches 20% in such individuals. Lifestyle intervention programmes and pharmacotherapy are effective in some individuals, but the relapse rate is high. In exceptional cases, bariatric surgery is effective. This review outlines the scale of the problem, highlights those at risk and discusses referral, current services, appropriate screening and therapeutic interventions.

scholarly journals Kidney outcomes three years after bariatric surgery in severely obese adolescents

2017 ◽  
Vol 91 (2) ◽  
pp. 451-458 ◽  
Author(s):  
Edward J. Nehus ◽  
Jane C. Khoury ◽  
Thomas H. Inge ◽  
Nianzhou Xiao ◽  
Todd M. Jenkins ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Obese Adolescents ◽  
Severely Obese

Correlates of Suicidal Ideation and/or Behavior in Bariatric-Surgery-Seeking Individuals With Severe Obesity

Crisis ◽  
2012 ◽  
Vol 33 (3) ◽  
pp. 137-143 ◽  
Author(s):  
E. Y. Chen ◽  
K. C. Fettich ◽  
M. S. McCloskey
Keyword(s):  
Bariatric Surgery ◽  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Severe Obesity ◽  
Suicide Attempts ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Related Stigma ◽  
Severely Obese ◽  
And Control

Background: Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an individual more vulnerable to social isolation, a potential risk factor for suicidal ideation and/or behavior. Aims: In this cross-sectional study of surgery-seeking adults with severe obesity, we examined whether weight-related stigma increases (1) the likelihood of suicidal ideation and/or behavior or (2) the degree of loneliness; and whether hypotheses (1) and (2) are supported (3) if loneliness mediates the effect of weight-related stigma on suicidal ideation and/or behavior. Methods: Online questionnaires were administered to 301 women and 95 men seeking bariatric surgery. Results: Approximately 30.3% reported having at least a passing thought of suicide, and 5.55% a suicide attempt during their lifetime. The suicide attempt rate appears lower than other bariatric surgery samples, but possibly higher than community and other surgery sample rates. For severely obese surgery-seeking women, weight-related stigma was associated with suicidal ideation and/or behavior, though this was not mediated by loneliness. Conclusions: Future studies are needed to model and compare suicidal ideation and/or behavior in bariatric-surgery-seeking individuals and control groups.

scholarly journals Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Michelle Maher ◽  
Mohammed Faraz Rafey ◽  
Helena Griffin ◽  
Katie Cunningham ◽  
Francis M Finucane
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Glycaemic Control ◽  
Severe Obesity ◽  
Meal Replacement ◽  
Agonist Therapy ◽  
Severely Obese ◽  
Skimmed Milk

Summary A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. Learning points: Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss. Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up. For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option. Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary. In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.

scholarly journals “The Balloon was Just the Kick Start I Had to do the Rest Myself”: Adolescents Living with Severe Obesity Experiences of an Intra-Gastric Balloon Alongside a Lifestyle Support Programme

2021 ◽  
Author(s):  
Lindsey J. Reece ◽  
Paul Bissell ◽  
Pooja Sachdev ◽  
Neil P. Wright ◽  
Seema Mihrshahi ◽  
...  
Keyword(s):  
Family Involvement ◽  
Research Study ◽  
Severe Obesity ◽  
Treatment Options ◽  
Critical Factor ◽  
Gastric Balloon ◽  
Obese Adolescents ◽  
Health And Wellbeing ◽  
Support Programme ◽  
Severely Obese

Abstract Background: Few treatments exist for adolescents living with severe obesity. This qualitative study explored the experiences of severely obese adolescents and their families who participated in the BOB study.Methods: Twelve adolescents (5 males;7 females; mean age 15 years; BMI > 3.5 s.d; puberty stage 4 +) who were engaged with the research study BOB (a non-randomised, pilot novel obesity treatment programme that involved the insertion of an intra-gastric balloon coupled with a family lifestyle behavioural support programme). Adolescents attended weekly lifestyle sessions before, during and post balloon insertion. All participants were interviewed at 3 months, (halfway through intra-gastric balloon insertion) and at 12 months follow-up (6 months post intra-gastric balloon removal, 3 months post lifestyle intervention).Results: All BOB participants had exhausted all treatment options deeming this study their final option. Many alluded to feelings of desperation and referred to a sense of hope that this intervention would be effective. Family involvement and attendance within the structured sessions differed significantly. Adolescents and parents perceived support from the research study ceased when the intra-gastric balloon was removed at 6-months despite attendance post balloon removal being poor. All participants emphasised a need for further support longer term with the integration of the family a critical factor.Conclusions: Further research is needed to explore the specific role families play within treatment to optimise health and wellbeing outcomes. Adolescents perspectives should be integrated within treatment to inform and improve the effectiveness of future treatment programmes for severely obese adolescents and their families.

scholarly journals “The balloon was just the kick start, I had to do the rest myself”: Adolescents living with severe obesity experiences of an intra-gastric balloon alongside a lifestyle support programme

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lindsey J. Reece ◽  
Paul Bissell ◽  
Pooja Sachdev ◽  
Neil Wright ◽  
Seema Mihrshahi ◽  
...  
Keyword(s):  
Family Involvement ◽  
Research Study ◽  
Severe Obesity ◽  
Treatment Options ◽  
Critical Factor ◽  
Gastric Balloon ◽  
Obese Adolescents ◽  
Health And Wellbeing ◽  
Support Programme ◽  
Severely Obese

Abstract Background Few treatments exist for adolescents living with severe obesity. This qualitative study explored the experiences of severely obese adolescents and their families who participated in the BOB study. Methods Twelve adolescents (5 males;7 females; mean age 15 years; BMI > 3.5 s.d; puberty stage 4 +) who were engaged with the research study BOB (a non-randomised, pilot novel obesity treatment programme that involved the insertion of an intra-gastric balloon coupled with a family lifestyle behavioural support programme). Adolescents attended weekly lifestyle sessions before, during and post balloon insertion. All participants were interviewed at 3 months, (halfway through intra-gastric balloon insertion) and at 12 months follow-up (6 months post intra-gastric balloon removal, 3 months post lifestyle intervention). Results All BOB participants had exhausted all treatment options deeming this study their final option. Many alluded to feelings of desperation and referred to a sense of hope that this intervention would be effective. Family involvement and attendance within the structured sessions differed significantly. Adolescents and parents perceived support from the research study ceased when the intra-gastric balloon was removed at 6-months despite attendance post balloon removal being poor. All participants emphasised a need for further support longer term with the integration of the family a critical factor. Conclusions Further research is needed to explore the specific role families play within treatment to optimise health and wellbeing outcomes. Adolescents perspectives should be integrated within treatment to inform and improve the effectiveness of future treatment programmes for severely obese adolescents and their families.

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