TEEN-BEST

Lifestyle interventions are the standard treatment for adolescents with severe obesity. However, only a small subgroup of adolescents with severe obesity are responsive to these lifestyle interventions. Recent literature supports the use of bariatric surgery in unresponsive adolescents. In the Netherlands bariatric surgery in adolescents is only allowed in the context of scientific research.
Therefore, the aim of this multicenter prospective cohort study of adolescents with severe obesity who are undergoing a Roux-en-Y gastric bypass(RYGB) or sleeve gastrectomy(SG) in combination with a multidisciplinary lifestyle intervention is to implement and assess the feasibility, efficacy and safety of this treatment modality in the Netherlands. A historical cohort of adolescents who only received a lifestyle intervention will be compared to the surgical cohort.

The overall aim of this study is to implement bariatric surgery including the multidisciplinary care pathway around the procedure for unsuccessfully treated adolescents with severe obesity in the Netherlands. Therefore, feasibility, efficacy and safety of bariatric surgery in adolescents will be assessed. Furthermore, clinical outcomes will be measured and compared with those of a historical cohort of patients participating in a lifestyle intervention program.
By assessing feasibility, efficacy and safety we aim to evaluate and optimize the multidisciplinary care pathway for adolescents with severe obesity undergoing bariatric surgery.

Primary outcomes:
(i) Proportion of adolescents presented to the national board achieving 20% total weight loss (%TWL) 1 year after surgery;
(ii) Incidence of adverse health events and additional surgical intervention during 5 years follow-up.

Secondary outcomes:
(i) Number of appointments per discipline and follow-up attendance during 5 years follow-up;
(ii) Patient satisfaction at 1, 3 and 5 years after surgery and satisfaction of the multidisciplinary team members after 1, 3 and 5 years from start of the study;
(iii) Perceived organization of care by the multidisciplinary team members after 1, 3 and 5 years from start of the study.

(iv) Change in body weight, change in body mass index (BMI), %TWL and change in BMI standard deviation score during 5 years follow-up;
(v) Prevalence and remission of obesity-related comorbidities during 5 years follow-up;
(vi) Prevalence of cardio metabolic health parameters during 5 years follow-up;
(vii) Bone health measures and incidence of bone fractures during 5 years follow-up;
(viii)Quality of life, psychosocial health measures, and educational attainment at 1, 3 and 5 years after surgery;
(ix) Body composition at 2 and 5 years after surgery.

Roux-en-Y gastric bypass (RYGB)
Sleeve Gastrectomy (SG)