RESUMEN
OBJECTIVE: To separately compare the long-term risk of mortality among bariatric surgical patients undergoing either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) to large, matched, population-based cohorts of patients with severe obesity who did not undergo surgery. BACKGROUND: Bariatric surgery has been associated with reduced long-term mortality compared to usual care for severe obesity which is particularly relevant in the COVID-19 era. Most prior studies involved the RYGB operation and there is less long-term data on the SG. METHODS: In this retrospective, matched cohort study, patients with a body mass index ≥35 kg/m 2 who underwent bariatric surgery from January 2005 to September 2015 in three integrated health systems in the United States were matched to nonsurgical patients on site, age, sex, body mass index, diabetes status, insulin use, race/ethnicity, combined Charlson/Elixhauser comorbidity score, and prior health care utilization, with follow-up through September 2015. Each procedure (RYGB, SG) was compared to its own control group and the two surgical procedures were not directly compared to each other. Multivariable-adjusted Cox regression analysis investigated time to all-cause mortality (primary outcome) comparing each of the bariatric procedures to usual care. Secondary outcomes separately examined the incidence of cardiovascular-related death, cancer related-death, and diabetes related-death. RESULTS: Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. RYGB and SG were each associated with a significantly lower risk of all-cause mortality compared to nonsurgical patients at 5-years of follow-up (RYGB: HR = 0.43; 95% CI: 0.35,0.54; SG: HR = 0.28; 95% CI: 0.13,0.57) Similarly, RYGB was associated with a significantly lower 5-year risk of cardiovascular-(HR = 0.27; 95% CI: 0.20, 0.37), cancer- (HR = 0.54; 95% CI: 0.39, 0.76), and diabetes-related mortality (HR = 0.23; 95% CI:0.15, 0.36). There was not enough follow-up time to assess 5-year cause-specific mortality in SG patients, but at 3-years follow-up, there was significantly lower risk of cardiovascular- (HR = 0.33; 95% CI:0.19, 0.58), cancer- (HR = 0.26; 95% CI:0.11, 0.59), and diabetes-related (HR = 0.15; 95% CI:0.04, 0.53) mortality for SG patients. CONCLUSION: This study confirms and extends prior findings of an association with better survival following bariatric surgery in RYGB patients compared to controls and separately demonstrates that the SG operation also appears to be associated with lower mortality compared to matched control patients with severe obesity that received usual care. These results help to inform the tradeoffs between long-term benefits and risks of bariatric surgery.
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COVID-19 , Derivación Gástrica , Obesidad Mórbida , Humanos , Obesidad Mórbida/cirugía , Estudios de Cohortes , Estudios Retrospectivos , GastrectomíaRESUMEN
OBJECTIVE: To evaluate the effect of computer-assisted decision tools that standardize pediatric weight management in a large, integrated health care system for the diagnosis and management of child and adolescent obesity. STUDY DESIGN: This was a large scale implementation study to document the impact of the Kaiser Permanente Southern California Pediatric Weight Management Initiative. An average of 739, 816 outpatient visits per year in children and adolescents from 2007 to 2010 were analyzed. Height, weight, evidence of exercise and nutrition counseling, and diagnoses of overweight and obesity were extracted from electronic medical records. RESULTS: Before the initiative, 66% of all children and adolescents had height and weight measured. This increased to 94% in 2010 after 3 years of the initiative (P < .001). In children and adolescents who were overweight or obese, diagnosis of overweight or obesity increased significantly from 12% in 2007 to 61% in 2010 (P < .001), and documented counseling rates for exercise and nutrition increased significantly from 1% in 2007 to 50% in 2010 (P < .001). CONCLUSIONS: Computer-assisted decision tools to standardize pediatric weight management with concurrent education of pediatricians can substantially improve the identification, diagnosis, and counseling for overweight or obese children and adolescents.
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Toma de Decisiones Asistida por Computador , Adhesión a Directriz/estadística & datos numéricos , Obesidad/terapia , Sobrepeso/terapia , Guías de Práctica Clínica como Asunto , Pérdida de Peso , Programas de Reducción de Peso/estadística & datos numéricos , Adolescente , Índice de Masa Corporal , California/epidemiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Obesidad/epidemiología , Sobrepeso/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Programas de Reducción de Peso/normasRESUMEN
OBJECTIVE: To estimate the prevalence of extreme obesity in a large, multiethnic contemporary cohort of children and adolescents. STUDY DESIGN: In a cross-sectional study, measured weight and height were extracted from electronic medical records of 710,949 patients aged 2 to 19 years (87.8% of eligible patients) who were enrolled in an integrated prepaid health plan in 2007 and 2008. Prevalence of extreme obesity was defined as body mass index (BMI)-for-age>or=1.2 times 95th percentile or BMI>or=35 kg/m2. RESULTS: Extreme obesity was observed in 7.3% of boys and 5.5% of girls. The prevalence peaked at 10 years of age in boys and at 12 years of age with a bimodal distribution in girls (second peak at 18 years; P value for sex x age interaction=.036). The prevalence of extreme obesity varied in ethnic/racial and age groups, with the highest prevalence in Hispanic boys (as high as 11.2%) and African-American girls (as high as 11.9%). CONCLUSION: Extreme obesity in Southern California youth is frequently observed at relatively young ages. The shift toward extreme body weights is likely to cause an enormous burden of adverse health outcomes once these children and adolescents grow older.
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Negro o Afroamericano/estadística & datos numéricos , Índice de Masa Corporal , Hispánicos o Latinos/estadística & datos numéricos , Obesidad/diagnóstico , Obesidad/etnología , Adolescente , Factores de Edad , Estatura , Peso Corporal , California/epidemiología , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVE: To study overweight and aerobic fitness among children in the third and fourth grades of elementary schools in a city in the United States of America (El Paso, Texas) and a city in Mexico (Chihuahua, Chihuahua) that are on or near the border between those two countries, and to compare the results from those two cities with earlier findings for other children in the United States. METHODS: We followed the El Paso children (427 boys and 385 girls, 93% of them of Mexican descent) from third to fourth grade and assessed the change in their body mass index (BMI). In the city of Chihuahua we cross-sectionally measured the BMI of a sample of third grade children (221 boys and 237 girls) and a sample of fourth grade children (268 boys and 215 girls). BMI and triceps skinfolds were measured for all the children studied in the two cities. BMI was used to assess risk for overweight (at least the 85th percentile BMI for age and gender) and overweight (at least the 95th percentile BMI for age and gender) in all the children. The distance that El Paso children ran in nine minutes was used to assess their aerobic fitness (aerobic fitness was not measured in the Chihuahua children). The data from El Paso were collected in 1999, 2000, and 2001, and the Chihuahua data were collected in 2000 and 2001. RESULTS: In the El Paso boys, overweight significantly increased in the one year from third grade to fourth grade, from 22% to 28%, while risk for overweight significantly increased, from 37% to 44%. In the El Paso girls, risk for overweight significantly increased over the same one-year period, from 29% to 37%. The El Paso boys and girls were significantly less fit when compared to samples of children from throughout the United States. Third and fourth grade children from Chihuahua had similar rates of risk for overweight and of overweight when compared to the children from the same grades in El Paso. CONCLUSIONS: Children in both El Paso and Chihuahua were more overweight than were non-Hispanic white children throughout the United States. In addition, the children in El Paso were less aerobically fit than were non-Hispanic white children and than were other Mexican-American children in the United States. These results clearly show that efforts should be made in the border regions of both Mexico and the United States to develop physical activity and nutrition programs to help stem rising rates of overweight.
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Obesidad/epidemiología , Aptitud Física , Niño , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , México/epidemiología , Estados Unidos/epidemiologíaRESUMEN
OBJETIVO: Estudiar el sobrepeso y el acondicionamiento aeróbico en niños de tercero y cuarto grado de primaria en una ciudad de Estados Unidos de América (El Paso, Texas) y una ciudad de México (Chihuahua, Chihuahua), ambas situadas en la frontera entre esos dos países o cerca de ella, así como comparar los resultados observados en esas dos ciudades con resultados obtenidos anteriormente en otras muestras infantiles en Estados Unidos. MÉTODOS: Seguimos a un grupo de niños en El Paso (427 varones y 385 niñas, 93% de los cuales eran de ascendencia mexicana) que cursaban el tercero o cuarto grado de primaria y evaluamos cambios en el índice de masa corporal (IMC). En la ciudad de Chihuahua medimos el IMC en una muestra transversal de niños de tercer grado (221 varones y 237 niñas) y de cuarto grado (268 varones y 215 niñas). A todos los niños estudiados en ambas ciudades se les tomaron mediciones de IMC y del pliegue cutáneo del tríceps. El IMC se usó para estimar el riesgo de sobrepeso (un IMC igual o mayor al del percentil 85 para la edad y el sexo) y para detectar la presencia de sobrepeso (un IMC igual o mayor al del percentil 95 para la edad y el sexo). La distancia que los niños en El Paso corrieron en nueve minutos se usó para evaluar su grado de acondicionamiento aeróbico (el cual no se midió en los niños de Chichuaua). En El Paso los datos se recolectaron en 1999, 2000 y 2001 y en Chichuahua, en 2000 y 2001. RESULTADOS: En los varones de El Paso se observó un aumento significativo de 22 a 28% en la frecuencia de sobrepeso durante el año transcurrido entre tercero y cuarto de primaria, así como un aumento significativo de 37 a 44% en el riesgo de sobrepeso. En las niñas de El Paso se produjo un aumento significativo del riesgo de sobrepeso, de 29 a 37%, en el mismo período de un año. Los varones y las niñas en El Paso mostraron un estado de acondicionamiento aeróbico menor, en grado significativo, que muestras de niños de ambos sexos tomadas en distintas partes de los Estados Unidos. Los niños de tercero y cuarto grado de primaria en Chihuahua mostraron tasas de riesgo de sobrepeso y de sobrepeso similares a las de los niños que cursaban los mismos grados en El Paso...
Objective. To study overweight and aerobic fitness among children in the third and fourth grades of elementary schools in a city in the United States of America (El Paso, Texas) and a city in Mexico (Chihuahua, Chihuahua) that are on or near the border between those two countries, and to compare the results from those two cities with earlier findings for other children in the United States. Methods. We followed the El Paso children (427 boys and 385 girls, 93% of them of Mexican descent) from third to fourth grade and assessed the change in their body mass index (BMI). In the city of Chihuahua we cross-sectionally measured the BMI of a sample of third grade children (221 boys and 237 girls) and a sample of fourth grade children (268 boys and 215 girls). BMI and triceps skinfolds were measured for all the children studied in the two cities. BMI was used to assess risk for overweight (at least the 85th percentile BMI for age and gender) and overweight (at least the 95th percentile BMI for age and gender) in all the children. The distance that El Paso children ran in nine minutes was used to assess their aerobic fitness (aerobic fitness was not measured in the Chihuahua children). The data from El Paso were collected in 1999, 2000, and 2001, and the Chihuahua data were collected in 2000 and 2001. Results. In the El Paso boys, overweight significantly increased in the one year from third grade to fourth grade, from 22% to 28%, while risk for overweight significantly increased, from 37% to 44%. In the El Paso girls, risk for overweight significantly increased over the same oneyear period, from 29% to 37%. The El Paso boys and girls were significantly less fit when compared to samples of children from throughout the United States. Third and fourth grade children from Chihuahua had similar rates of risk for overweight and of overweight when compared to the children from the same grades in El Paso. Conclusions. Children in both El Paso and Chihuahua were more overweight than were non-Hispanic white children throughout the United States. In addition, the children in El Paso were less aerobically fit than were non-Hispanic white children and than were other Mexican American children in the United States. These results clearly show that efforts should be made in the border regions of both Mexico and the United States to develop physical activity and nutrition programs to help stem rising rates of overw
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Humanos , Masculino , Femenino , Niño , Obesidad/epidemiología , Aptitud Física , Estudios Transversales , Estudios de Seguimiento , México/epidemiología , Estados Unidos/epidemiologíaAsunto(s)
Obesidad , Estudios Transversales , Aptitud Física , Estudios de Seguimiento , México , Estados UnidosRESUMEN
One goal of national health-promotion research is to disseminate and institutionalize experimentally tested programs in local communities. In 1997, the national Child and Adolescent Trial for Cardiovascular Health (CATCH) was chosen by the Paso del Norte Health Foundation as their first community-wide preventive health initiative for the El Paso, Texas/Juárez, México border region. With help from researchers at the University of Texas at Houston, evaluators from the University of Texas at El Paso, and the Region 19 Educational Services Center, CATCH was implemented in 18 Title I pilot schools. Known as the Coordinated Approach to Child Health 5 years later, the El Paso CATCH program has been embraced by the border community and reaches 108 elementary schools from New Mexico to West Central Texas. There are also plans to implement CATCH in Juárez. This article describes the institutionalization of CATCH in a predominately Hispanic, low income border region.
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Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/prevención & control , Difusión de Innovaciones , Educación en Salud/organización & administración , Promoción de la Salud/organización & administración , Americanos Mexicanos/educación , Servicios de Salud Escolar/organización & administración , Adolescente , Niño , Cultura , Educación en Salud/normas , Promoción de la Salud/normas , Humanos , Americanos Mexicanos/psicología , México/etnología , Innovación Organizacional , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud/métodos , Servicios de Salud Escolar/normas , TexasRESUMEN
El Paso Coordinated Approach to Child Health (El Paso CATCH) was evaluated in 24 schools for outcome measures of moderate to vigorous physical activity (MVPA) during physical education (PE), content of PE lessons, content of school meals, and numerous process measures. Chi-square analyses compared frequency data across time for activity during PE and percentage fat in school meals. Descriptive summaries were used for process questionnaire results. Data were also compared to CATCH program goals. For most intervention schools, El Paso CATCH significantly increased MVPA, decreased fat in school meals, and decreased sodium in school breakfasts. However, some schools were not meeting the fat content goals for school lunches, and no schools met the vigorous physical activity (VPA) goals for PE or the sodium goals for school lunches.