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The Need for a Socioecological Framework to Maximize Health Outcomes in Pediatric Populations with S

Joshua Yudkin

University of Texas School of Public Health

Purpose: The rates of both severe obesity in youth and adolescent bariatric surgery continue to rise worldwide. The gap and lack of coordination between lifestyle interventions and bariatric surgery as a treatment option for adolescents is understudied. This review investigates how lifestyle interventions for severe obesity could be combined/sequenced with bariatric surgery over time to optimize health and psychosocial outcomes and introduces a comprehensive theoretical framework for future research. Methods: This review includes the 33 articles that studied the combination of healthy lifestyle intervention and bariatric surgery among adolescents between 1995 and 2018. Results: No studies reported effect sizes for the combination of both interventions. Previous studies reported results for either lifestyle intervention or surgery, but not for their compound effect. Theoretical frameworks and constructs, comprehensive evidenced-based, feasible clinical recommendations, and sustainable policies were all effectively absent from the literature. Conclusions: As severe obesity in youth is on the rise globally, future research should focus on how partnering lifestyle interventions with bariatric surgery can amplify positive short-and long-term health outcomes and clarify how to coordinate these two intervention approaches. This comprehensive approach must account for key constructs from a socioecological framework such as the novel one proposed in this paper. High-risk and vulnerable populations such as ethnic minorities who have suffered a disproportionate burden of the obesity epidemic must be included in rigorously tested future trials. Ultimately, coordinated and comprehensive interventions will lead to clinical recommendations and policies that will create a sustainable improvement in patient quality of life worldwide.

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