Pediatric metabolic and bariatric surgery (MBS) can provide life-changing benefits for adolescents living with obesity. However, after surgery many adolescents struggle to follow the diet and exercise plans that are critical to sustaining those benefits.
Children’s Medical Center Dallas, part of Children’s HealthSM, is working in collaboration with UT Southwestern and the UTHealth Houston School of Public Health to pilot an innovative program that provides adolescents the support they need. The program, called TeenLYFT, delivers a series of web-based tutorial videos to adolescents for before and after MBS, covering a variety of topics, such as diet, exercise and mental health tips.
The program was designed using input from teens and parents, and early analysis shows it succeeds in helping adolescents meet their health goals.
“Lifestyle modification is a fundamental part of every weight-loss intervention – it’s also the hardest,” saysBethany Cartwright, M.D., Ph.D., Pediatric Endocrinologist at Children’s Health and Assistant Professor at UT Southwestern. “We’re committed to exploring new modes and methods to help adolescent patients maximize the benefits of MBS.”
MBS during adolescence gives the body time to change course
The benefits of MBS include both reduced weight and protection against type 2 diabetes (T2D). These benefits stem from the patient’s smaller stomach capacity and a range of metabolic changes triggered by their new anatomy. For example, patients have higher levels of GLP-1 after surgery, leading to greater glucose sensitivity and lower levels of ghrelin, which leads to lower appetite.
These changes help explain why 50-60% of adolescents show remission of T2D following laparoscopic sleeve gastrectomy, the type of MBS most often performed at Children’s Health.
“Research also shows that the improvement of weight-related health complications following MBS is typically more positive for teens than for adults. Intervening early gives the body the best chance to counteract the consequences of obesity – ‘before the train has left the station,” says Dr. Cartwright.
Nutrient deficiencies are a common risk
Adolescents must follow a restricted diet of 600-800 calories per day to protect against stretching their smaller stomachs and straining the surgical seams. At the same time, the surgery involves changes to their digestive tract that leaves it less capable of absorbing nutrients.
“It all adds up to making every bite count: prioritize nutrition and minimize empty calories,” Dr. Cartwright explains.
To help adolescents meet their nutrition needs, MBS programs prescribe a strict regimen of vitamin supplements and provide counseling with social workers and dietitians. Teens start their diet and vitamin regimens before surgery, to get used to them. The counseling continues after surgery, to help teens follow through.
But often it isn’t enough: deficiencies in iron, Vitamin D, vitamin B12, and other nutrients are a nagging problem after MBS, and appear more common among adolescents than adults.
Dr. Cartwright isn’t surprised. “Following the recommendations is hard enough for adults. Teens haven’t exercised anything near this level of care and control over their choices before. They need more help,” she says.
A solution designed for teens, with teens
TeenLYFT is special not only because it provides more support but also because it satisfies the needs and priorities identified by adolescents themselves. The team conducted surveys and interviews with patients and parents to inform the program’s design, including what information teens wanted and how they wanted it delivered.
That research proved that most adolescents preferred online content over in-person counseling. And the content they requested included some surprises. “Their top three priorities were healthy eating habits, managing stress and staying motivated,” says Dr. Cartwright. “This proves that mental health plays an important role in a teen’s journey after MBS.”
As a result, the TeenLYFT curriculum consists of four categories: eating behaviors, physical activity, stress management and motivation. Teens can stream new videos from each category on a weekly basis, and the content matches where they are each week in their MBS journey. For example, dietary videos shortly after surgery focus on managing a liquid diet, and later they transition to advice about solid foods.
Content about diet and exercise draws on material from the well-established Diabetes Prevention Program (DPP). The mental health content was steered by Alicia Wheelington, Ph.D., a Pediatric Psychologist at Children’s Health who was a core member of the TeenLYFT program.
The team was led by Sarah Messiah, Ph.D., MPH, Director of the Child and Adolescent Population Health Program at UT Southwestern, and included Sarah Barlow, M.D., Pediatric Gastroenterologist at Children’s Health and Professor at UT Southwestern, and other experts in exercise physiology.
“We designed TeenLyFT with the same multidisciplinary approach we bring to patients in the clinic,” says Dr. Cartwright.
Next up: Clinical trial and possible expansion
The team is still analyzing data on the pilot program and aims to publish soon. Results indicate TeenLYFT is helping patients commit to lifestyle changes and get the nutrients they need. Results emphasize that adapting standardized lifestyle interventions after bariatric surgery helps maximize health outcomes.
“We see a marked rise in physical activity between three and four months – a positive sign that our strategies are working and teens are engaging with the content,” says Dr. Cartwright.
The team will continue developing the program after the pilot, housing the content in a TeenLYFT mobile app and deploying it in a randomized control trial. Building the app will make it easier to track usage and nudge patients who aren’t engaging with the content.
Eventually, Dr. Cartwright hopes programs like TeenLYFT become commonplace across the country and will expand to other patient groups, like people who use weight-loss medication.
“Whether you’ve had MBS or you take an anti-obesity medication, your best outcomes depend on your daily choices. We want patients to know they’re not alone and we have the resources to help them thrive,” she says.
Learn more about innovative weight management for children and adolescents at Children’s Health.
