Severe obesity in young adults : characterization and treatment outcomes with emphasis on mental health aspects

Background: Obesity (body mass index [BMI] ≥30 kg/m2) is associated with a range of physical and psychiatric comorbidities and premature mortality. Young adulthood (here 16-25 years) constitutes a vulnerable period for weight gain, poor weight loss results, and mental health problems. Up to 8.3% of Swedish young adults are classified as obese. In spite of the fact that the peak incidence for obesity occurs during young adulthood, this age period has been generally overlooked in clinical obesity research, particularly in regard to obesity-related mental health problems. Aim: To characterize severe obesity (BMI ≥35 kg/m2) in young adulthood (16-25 years) with emphasis on mental health aspects, and to study long-term outcomes (weight loss, adverse events, loss-to-follow-up and health-related quality of life [HRQL]) in young (18-25 years) vs older (≥26 years) adults after Roux-en-Y gastric bypass (RYGB). Methods: In Study I, we used cross-sectional self-reported questionnaire data on obesity-related comorbidities, mental health, self-esteem, lifestyle and health-related quality of life; physical fitness tests; biochemical data on micronutritional deficiencies; and anthropometry from n=165 young adults, aged 16-25 years who were about to start treatment at the Karolinska University Hospital Obesity Center. In Study II, we compared cross-sectional questionnaire patient data (n=121 treatment-seekers to the Obesity Center, 18-25 years) on mental distress, self-reported suicide attempts, physical/psychosomatic symptoms, and quality of life with data on n=363 normal-weight responders to the Stockholm Public Health Cohort 2010 who were individually matched 3:1 for age, gender and socioeconomic status. For Studies III-IV, we frequency matched n=3,531 young (18-25 years) to n=17,137 older (26-74 years) patients in the Scandinavian Obesity Surgery Registry for BMI, gender and year of surgery to compare weight loss, adverse events, loss-to-follow-up and changes in HRQL between matching groups. Results: In Study I, we found consistent indications of poor mental and obesity-related health problems (up to 55%), high levels of cardiometabolic risk factors (up to 82%) and micronutritional deficiencies (48%) in treatment-seeking young adults (mean BMI 39.2 kg/m2 [SD: 5.2], 80% women). In Study II, we found an increased risk of mental distress (adjusted relative risk [RR]=1.76, 95% CI: 1.38-2.24), suicide attempts (adjusted RR=2.04, 95% CI: 1.06-3.95), physical/psychosomatic symptoms (adjusted RR=1.59-2.95) and poor quality of life (range of adjusted RR=1.97-6.61) in obese treatment-seekers (mean BMI 39.8 kg/m2 [SD: 5.3], 81% women) compared to population controls (mean BMI 22.4 kg/m2 [SD: 4.0], 81% women). In Study III, a total of n=369 young (37.0% of eligible) and n=2,210 older (46.1%) adults were followed-up 5 years after RYGB. Young adults displayed higher weight loss (31.8% vs 28.2%) at 5 years, more long-term adverse events (any kind of adverse events between 2-5 years: 20.3% vs 12.7%, adjusted OR=1.72, 95% CI: 1.29-2.31; serious adverse events between 2-5 years [Clavien-Dindo ≥3b]: 14.1% vs 6.9%, adjusted OR=2.06, 95% CI: 1.45-2.92) and higher loss-to-follow-up throughout the study period (range of adjusted RR=1.16-2.13), all, p <0.001. In Study IV, n=138 young (20.7% of those eligible) and n=1,021 older (31.8%) adults were available for follow-up 5 years post-RYGB. Both young and older adults displayed clinically relevant improvements in physical HRQL 5 years after RYGB compared to baseline values, while no change or deterioration in mental HRQL was observed in both groups. Older adults generally experienced greater HRQL improvements than the young adults in adjusted analyses. Conclusion: Treatment-seeking young adults with severe obesity constitute a vulnerable patient group with a wide array of obesity-related comorbidities, particularly mental health issues. While we found promising weight loss results and improvements in physical HRQL in young adults 5 years after RYGB, there were also higher numbers of long-term adverse events, drop-outs and generally poor improvements in HRQL in young vs older adults. Future research needs to address the impact of mental distress on the development and treatment of obesity in young adults. Studies on the significance of and the etiology behind our data showing more serious adverse events and higher loss-to-follow-up in the younger RYGB-patients are needed

Creative destruction in science

Drawing on the concept of a gale of creative destruction in a capitalistic economy, we argue that initiatives to assess the robustness of findings in the organizational literature should aim to simultaneously test competing ideas operating in the same theoretical space. In other words, replication efforts should seek not just to support or question the original findings, but also to replace them with revised, stronger theories with greater explanatory power. Achieving this will typically require adding new measures, conditions, and subject populations to research designs, in order to carry out conceptual tests of multiple theories in addition to directly replicating the original findings. To illustrate the value of the creative destruction approach for theory pruning in organizational scholarship, we describe recent replication initiatives re-examining culture and work morality, working parents\u2019 reasoning about day care options, and gender discrimination in hiring decisions. Significance statement It is becoming increasingly clear that many, if not most, published research findings across scientific fields are not readily replicable when the same method is repeated. Although extremely valuable, failed replications risk leaving a theoretical void\u2014 reducing confidence the original theoretical prediction is true, but not replacing it with positive evidence in favor of an alternative theory. We introduce the creative destruction approach to replication, which combines theory pruning methods from the field of management with emerging best practices from the open science movement, with the aim of making replications as generative as possible. In effect, we advocate for a Replication 2.0 movement in which the goal shifts from checking on the reliability of past findings to actively engaging in competitive theory testing and theory building. Scientific transparency statement The materials, code, and data for this article are posted publicly on the Open Science Framework, with links provided in the article

Who is the Treatment-Seeking Young Adult with Severe Obesity: A Comprehensive Characterization with Emphasis on Mental Health.

To characterize treatment-seeking young adults (16-25 years) with severe obesity, particularly mental health problems.Cross-sectional study of 165 participants (132 women, 33 men) with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program.Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale) and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale); self-esteem (Rosenberg Self-Esteem Scale), suicide attempts, health-related quality of life (Short Form-36 Health Survey), psychosocial functioning related to obesity (Obesity-related Problems Scale), cardiorespiratory fitness (Astrand's bicycle ergometer test), somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology.Mean body mass index was 39.2 kg/m2 (SD = 5.2). We found evidence of poor mental health, including present psychiatric diagnoses (29%), symptomatology of anxiety (47%), depression (27%) and attention-deficit/hyperactivity disorder (37%); low self-esteem (42%), attempted suicide (12%), and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, P<0.001 for difference). Variables independently associated with present anxiety symptomatology (R2 = 0.33, P<0.001) included low self-esteem (P<0.001) and pain (P = 0.003), whereas present depressive symptomatology (R2 = 0.38, P<0.001) was independently associated with low self-esteem (P<0.001), low cardiorespiratory fitness (P = 0.009) and obesity-related problems (P = 0.018). The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at least one micronutritional deficiency, vitamin D being the most common (35%).A wide range of health issues, including quite severe mental health problems, was prevalent in treatment-seeking young adults with severe obesity. These are likely to constitute a major treatment challenge, including options relating to bariatric surgery

Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults : A Scandinavian Obesity Surgery Registry study.

BACKGROUND: Young adults display particularly poor weight loss in behavioral obesity treatment; nonetheless, they have seldom been included in bariatric research. OBJECTIVES: To compare weight loss, adverse events, and loss to follow-up in young (18-25 yr) versus older (≥26 yr) adults up to 5 years after Roux-en-Y gastric bypass. SETTING: Nationwide, register-based study, Sweden. METHODS: Prospective registry data (Scandinavian Obesity Surgery Register) were analyzed in young (22.2 yr [standard deviation (SD): 2.1], 81.6% women, mean body mass index 43.7 kg/m2 [SD: 5.4]) and older (42.6 years [SD: 9.6], 82.0% women, mean body mass index 43.4 kg/m2 [SD: 5.0]) adults undergoing Roux-en-Y gastric bypass. Groups were matched for body mass index, sex, and year of surgery. Regression analyses and mixed models were used to compare outcomes between groups. RESULTS: A total of 369 young (37.0% of eligible) and 2210 older (46.1%) adults attended the 5-year follow-up. At this time, weight loss was 31.8% in young and 28.2% in older adults (P &lt; .001), with a serious adverse event (Clavien-Dindo ≥3b) being reported in 52 (14.1%) young and 153 (6.9%) older adults (odds ratio = 2.06, 95% confidence interval: 1.45-2.92, P &lt; .001). Loss to follow-up was higher in young versus older adults throughout the study period (range of relative risk = 1.16-1.89, P &lt; .001). CONCLUSIONS: While young adults displayed at least equal weight loss as older adults, rates of adverse events were approximately doubled, and loss to follow-up rates were higher. Future studies on the significance of and the etiology behind the higher incidence of serious adverse events are needed. Intensified clinical contact post Roux-en-Y gastric bypass should have the potential to further improve outcomes in young adults

Estimated marginal means across quartiles of cardiorespiratory fitness, pain (yes/no), self-esteem and obesity related problems for anxiety and depression as measured by the Hospital Anxiety and Depression Scale (min-max: 0–21) in (n = 165) treatment-seeking young adults (16–25 y) with obesity.

<p>Values are mutually adjusted (except for cardiorespiratory fitness) for gender, age, body mass index, economic strain, hazardous alcohol consumption, insomnia, Homeostasis Model Assessment-Insulin resistance; and social support (all P>0.30). Error bars = 95% CI. ^a Astrand´s test [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145273#pone.0145273.ref025" target="_blank">25</a>]. ^b European Quality of Life-5 Dimensions [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145273#pone.0145273.ref042" target="_blank">42</a>]. ^c Rosenberg Self-Esteem Scale [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145273#pone.0145273.ref031" target="_blank">31</a>]. ^d Obesity-related Problems Scale [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145273#pone.0145273.ref033" target="_blank">33</a>].</p

Health-Related Quality of Life 5 Years After Roux-en-Y Gastric Bypass in Young (18-25 Years) Versus Older (≥ 26 Years) Adults : a Scandinavian Obesity Surgery Registry Study.

BACKGROUND: To compare changes in health-related quality of life (HRQoL) in young (18-25 years) versus older (≥ 26 years) adults up to 5 years after Roux-en-Y gastric bypass (RYGB). METHODS: Data on Short Form-36 (SF-36) and obesity-related problems scale (OP) at baseline and 1, 2, and 5 years after RYGB were extracted from the Scandinavian Obesity Surgery Registry. Within-group changes and the effect of age group on 5-year changes in SF-36 and OP were analyzed. Effects sizes (ESs) were calculated. RESULTS: A total of 2542 young and 12,425 older adults were included at baseline, and 138 young (20.7% of those eligible) and 1021 older (31.8%) adults were followed-up 5 years post-RYGB. At this time, average to large improvements (ES ≥ 0.5) were observed in physical functioning, physical component score and OP in young adults, and in physical functioning, role physical, general health, physical component score, and OP in older adults (all, p ≤ 0.001). Both age groups displayed negligible to weak (ES &lt; 0.5) or no improvements in mental HRQoL (all, p &lt; 0.55). Older adults displayed greater 5-year improvements than their young counterparts in role physical, general health, vitality, social functioning, physical component score, and obesity-related problems scale (all, p &lt; 0.05). CONCLUSIONS: Both young and older adults displayed improvements in OP and physical HRQoL 5 years post-RYGB compared to baseline, while mental HRQoL did not improve to the same extent. Greater HRQoL-improvements could be expected in older patients why future research on HRQoL post-RYGB should stratify data on age groups