Clinical Report: Follow-Up Adherence Challenges Post-Sleeve Gastrectomy in Adolescents and Young Adults
Overview
This study highlights the significant issue of inadequate follow-up adherence among adolescents and young adults (AYA) after sleeve gastrectomy. It demonstrates that loss to follow-up (LTF) negatively impacts long-term weight loss outcomes and identifies critical time points for intervention to improve adherence.
Background
Obesity prevalence is rising globally, with severe obesity increasing rapidly among children and adolescents. Bariatric surgery, particularly sleeve gastrectomy, is an effective treatment for refractory obesity in AYA, reducing comorbidities and improving quality of life. However, younger patients are at higher risk of being lost to follow-up postoperatively, which may compromise long-term outcomes. Understanding follow-up patterns and their impact on weight loss is essential to optimize care in this vulnerable population.
Data Highlights
The study included patients aged 14–26 undergoing sleeve gastrectomy between 2018 and 2023. Follow-up visits were scheduled at 1, 3, 6, 9, 12, 18, and 24 months postoperatively, with annual visits thereafter. Loss to follow-up was defined as failure to return after a specific postoperative time point. Data were collected from electronic medical records and the MBSAQIP database, with weight loss measured as median total weight loss percentage (%TWL) at each time point. Statistical analyses included descriptive statistics and univariate logistic regression to assess relationships between follow-up adherence and weight loss.
Key Findings
Adolescents (14–18 years) and young adults (19–26 years) showed differing patterns of follow-up adherence after sleeve gastrectomy.
Loss to follow-up increased cumulatively over time, with critical drop-off points identified at specific postoperative intervals.
Patients lost to follow-up demonstrated significantly lower median %TWL compared to those maintaining clinic visits.
Behavioral medicine and social work evaluations were integrated pre- and postoperatively, yet adherence challenges persisted, particularly in the AYA population.
Preoperative nicotine abstinence was enforced, and no patients were actively using nicotine perioperatively, minimizing confounding factors related to substance use.
Clinical Implications
Clinicians should recognize the high risk of follow-up interruption in adolescents and young adults after sleeve gastrectomy and implement targeted interventions at identified critical time points. Enhanced support systems, including behavioral health and social work services tailored to developmental needs, may improve adherence and optimize long-term weight loss outcomes. Routine monitoring and proactive outreach are essential to reduce loss to follow-up in this population.
Conclusion
Inadequate follow-up adherence post-sleeve gastrectomy in adolescents and young adults is a significant barrier to achieving optimal weight loss outcomes. Focused strategies addressing the unique challenges of this age group are necessary to improve long-term surgical success.
References
Various Authors/Multiple Sources/2020-2023 -- Obesity Prevalence and Bariatric Surgery Outcomes in Adolescents and Young Adults
