Background

Historically, adolescents and young adults (AYA) have poor follow-up after bariatric surgery. We sought to better understand the relationship between lost to follow-up (LTF) and weight loss velocity after bariatric surgery in an AYA population.

Methods

We analyzed institutional retrospective data from adolescents (age 14-19) and young adults (YA) (age >19-31) who underwent sleeve gastrectomy or gastric bypass between January 2018-May 2023. Total body weight loss (%TBWL) from post-operative visits (30 days to five years) was compared between adolescents and YA. For patients with one-year follow-up, weight loss velocity was stratified into tertiles of %TBWL. Regression analysis was used to compare weight loss and follow-up adherence.

Results

Median %TBWL at one year was similar between adolescents (n=79, 25.5 [IQR 21.5, 30]) and YA (n=251, 26 [21,33]) (p=0.899), which persisted through four-year follow-up. When stratified into %TBWL tertiles, patients in both age groups were more likely to be lost to follow-up if %TBWL was in the lowest tertile at 6 months (OR [95%CI], 2.42 [1.35-4.37], p=0.023) or at 12 months (7.39 [3.80-14.37], p<0.001). Patients had higher odds (OR 5.61 [1.93,16.28], p=0.001) of %TBWL in the highest tertile at one year if they attended >=6 dietician visits (pre- or post-operative).

Conclusions

Early identification of patients in the lower tertile of %TBWL at one year may identify candidates who could benefit from added services, particularly nutrition counseling. Further characterization of these populations may identify light touch, telemedicine-derived services that provide long-term weight loss benefit in the AYA population.