Corinn Cross, MD (Host): This is Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. I'm your host, Dr. Cori Cross. And today we'll discuss a recent study and published research on standardized lifestyle interventions for adolescents undergoing metabolic and bariatric surgery.

 With us today are three experts, Faisal Qureshi, Pediatric Surgeon and Director of the Adolescent Bariatric Surgical Center at Children's Health, Bethany Cartwright, Pediatric Endocrinologist at Children's Health, and Sarah Messiah, Director of the Child and Adolescent Population Health Program at UT Southwestern. Thank you all for being with us today.

Let's start with some background. Dr. Qureshi, can you share a bit about the safety and multidisciplinary approach to bariatric surgery for teens?

Faisal Qureshi, MD: Thank you for that. It's wonderful to be here. Bariatric surgery, or metabolic and bariatric surgery for teens has been around for over 20 years. We've been able to show time and time again that it is one of the most highly effective ways to get teens who are struggling with obesity to a better, more healthy weight.

However, as opposed to adults, teens and young people have different barriers to approaching metabolic and bariatric surgery. In order for us to get them through the procedure safely, we have to rely on a large team. This includes psychologists, social workers, nutritionists, endocrinologists, and other specialists who help us steer these teens with multiple problems through the bariatric surgery.

Host: Now you all worked together on a recently published study. Dr. Messiah, can you share the purpose of this study?

Sarah Messiah, PhD: Sure. So as Dr. Qureshi explained, bariatric surgery is one of the only safe and effective treatment tools for obesity among children and adolescents. However, interestingly enough, there is a major gap in the science, in the field, in the literature, in that there have been no supportive lifestyle interventions that have been standardized for this group of patients. So the purpose of this project was to build that program for these patients.

Host: Now, Dr. Cartwright, can you tell us how does adapting standardized lifestyle interventions maximize the health outcomes for these patients?

Bethany Cartwright, MD: So one of the most important issues that our bariatric surgery patients face is nutrition after the surgery and their ability to absorb vitamins. So it's really important for these patients to be careful, not just about the amount of food that they're eating, but also the quality of that food. If you take a diet that consists mostly of unhealthy processed foods and you just eat less of it, well, you might lose weight, but that won't necessarily improve your overall health.

So it's really important for us to educate our patients on not just how to stay within their calorie counts, but how to get enough protein and vitamins in their diet and enough physical activity after the surgery to make sure they're preserving the health of their whole body during their weight loss journey.

Now we have evidence in the literature that teens especially, compared to adults have increased trouble adhering to some of these nutritional recommendations post operatively; so there's a real need in the field to give these adolescents increased nutritional education and increased lifestyle support.

Host: Now I'm assuming that this is where the teen lift program comes in that the paper mentions. Dr. Messiah, what is that and how does it help adolescents who are undergoing metabolic and bariatric surgery? How does this research address these existing gaps, I guess?

Sarah Messiah, PhD: So TEENLIFT was the acronym that we chose along with our patient population that includes this lifestyle intervention, and we adapted it from an evidence based program called, and that's well known, the Diabetes Prevention Program, that has core dietary and physical activity strategies to improve dietary intake, physical activity levels after surgery.

But we also included stress management and motivation topics because these were two that were highly prioritized among both our adolescents and their parents as topics that they felt that they would need support with after surgery. So we adapted for this age group from the diabetes prevention program.

Given that that program obviously was for adults who are pre diabetic or diabetic, here for teenagers that are going through bariatric surgery, but may still have some of the same risks after.

Host: Through your study, what strategies did you find worked best to keep the teens on track and what lifestyle changes benefited them the most, both before and after surgery? Dr. Messiah, do you want to take this one?

Sarah Messiah, PhD: Sure. So our preliminary results are very encouraging and we have found that at three and six months post surgery that they are on track and losing weight and improving cardiometabolic outcomes. But they're also, interestingly enough, and between three and six months, really improving their physical activity levels.

So we feel like this is one of the major milestones of TEENLIFT at this point that maybe we're not seeing in the first three months the activity levels take off, but we're really starting to see it between three and six months. And we had many, many videos that showcased strength, flexibility, and cardiovascular exercises that they could do and model. And they seem to really like those. That's where we were getting the most feedback and viewership from.

Host: And how long did you actually follow these patients up for? Did you go past six months?

Sarah Messiah, PhD: No, this study was a pilot study just to follow up for six months. And, right now, the team is getting ready to submit the next iteration of this study, which will follow a new group for up to at least a year after surgery.

Host: Very interesting. So how does parent support and participation help these patients? Did the study address that at all?

Sarah Messiah, PhD: We had parent feedback from the very beginning because obviously a lot of these patients are going to be living at home after surgery and for several years in some cases. So we understand completely that children don't live in a vacuum and they're dependent on their parents for nutritional choices, physical activity choices, and so on.

So it was really important that we parents as well in the development of TEENLIFT curriculum. And so they gave us guidance too. They specifically wanted guidance on healthier choices for eating out. That was a big one for them. And then shopping for groceries and what were healthier choices that they could provide their children at home after surgery too.

So that was integrated into all of the dietary modules that are part of Team Lift.

Host: Being a parent as well as a pediatrician, that makes a lot of sense. Before we wrap up, is there anything else you'd like to share?

Mm hmm, mm

Faisal Qureshi, MD: Yeah, thank you so much. Something that I'd like to highlight is what Dr. Messiah said is once the kids undergo their weight loss procedure, it takes them several months to start really becoming engaged in their physical activity. Some of that is returned to the ability and agility to perform exercise and be engaged.

So I think that partnering with these types of strategies, which are specifically designed to standardizing lifestyle interventions after surgery, will help these young people get the most out of their weight loss surgery.

Bethany Cartwright, MD: I'd also just like to emphasize that in this current climate where there's a lot of interest in advanced treatments for weight loss, that lifestyle therapy is really considered the foundation to any weight loss strategy. Even those patients who are seeking the assistance of a weight loss surgery or even one of the new weight loss medications, that lifestyle piece is still crucial for optimizing outcomes, and the body's overall health during weight loss. So building lifestyle education programs like Teen Lift and making them widely available is going to be vitally important to make sure that we're going about these advanced weight loss treatments the right way for our patients.

Host: No, that's absolutely correct. I mean, lifestyle changes, we know, are just really the gold standard for being able to continue after.

, Well, to learn more about bariatric surgery at Children's Health and the exciting things going on there, please visit childrens.com. Thank you all so much for being here today and educating our listeners on such an important topic. Thank you for taking the time, um, and making this so accessible.

Sarah Messiah, PhD: Thank you for having us.

Bethany Cartwright, MD: Thank you.

Host: And thank you to our audience for listening to Pediatric Insights, Advances, and Innovations with Children's Health, where we explore the latest in pediatric care and research. You can find more information at Childrens.com, and if you found this podcast helpful, please rate, review, and share this episode, and please follow Children's Health on your social channels.