OBES SURG DOI 10.1007/s11695-015-1677-8
ORIGINAL CONTRIBUTIONS
Obese Adolescents Report Better Health-Related Quality of Life than Obese Young Adults John B. Dixon 1,3 & Toni L. Rice 1,2 & Elisabeth A. Lambert 1,2,4 & Gavin W. Lambert 2,5
# Springer Science+Business Media New York 2015
Abstract Background Impairment in health-related quality of life (HRQOL) is described as a major concern for severely obese adolescents seeking intentional weight loss. We aimed to compare HRQOL in obese adolescents seeking weight loss with body mass index (BMI)-matched younger adults and community norms. Methods Eighty-one adolescents (14–18.8 years) with BMI 30–60 kg/m2 completed the Short Form (SF)-36 prior to commencing a weight loss program. Each adolescent was matched for BMI and gender with two obese adults seeking weight loss, 10 and 20 years older, respectively. The groups were compared across all eight scale scores and mental and physical component summary scores (MCS and PCS). Summary scores were also compared to community norms. Results The adolescents had higher scores than those in their 20s for all SF-36 scales and summary scores, indicating better HRQOL. Compared with community norms, obese adolescents had lower PCS and comparable MCS scores. Both groups of adults had lower PCS scores, but MCS was lower in those in their 20s compared with both adolescents and those
* John B. Dixon [email protected] 1
Clinical Obesity Research, Baker IDI Heart & Diabetes Institute, 75 Commercial Road, PO Box 6492, Melbourne, VIC 3004, Australia
2
Human Neurotransmitters Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia
3
Primary Care Research Unit, Monash University, Melbourne, Australia
4
Department of Physiology, Monash University, Melbourne, Australia
5
Department of Medicine, Monash University, Melbourne, Australia
in their 30s. There were no gender differences in patterns of responses across the three age groups. Conclusions Obese adolescents seeking intentional weight loss have significant impairment in physical aspects of HRQOL, but self-reported mental HRQOL appears to be similar to community controls. In contrast, obese participants in their 20s report clinically significant impairment in mental HRQOL. When considering adolescents for bariatric surgery, careful assessment is needed. We need a greater understanding of the emotional distress reported by those in their 20s. Keywords Mental health . Emotional wellbeing . Teens . Bariatric surgery . Intentional weight loss
Introduction Bariatric-metabolic surgery in adolescents is controversial and raises many ethical and practical issues [1]. As an established effective therapy successfully used in adults, it should be carefully evaluated in adolescents [2]. In comparison to intensive behavioral and pharmaceutical therapies for illnesses of childhood and adolescence, bariatric–metabolic surgery has some special barriers that need to be considered: surgery of any type involves physical and physiological changes to healthy normal organs; these changes will have benefits and risks, and some risks may be specific to the age group; these changes are designed to be permanent, and the potential for reversibility of procedures varies considerably. Therefore, embarking on bariatric surgery in adolescents is a decision for life that needs to be undertaken cautiously. Guidelines for the use of bariatric surgery in adolescents are usually conservative, requiring body mass index (BMI) levels equivalent to adults or greater (equating to a larger departure from normal), major obesity-related complications,
OBES SURG
having attained or almost attained physiological maturity, having failed formally supervised lifestyle and behavioral programs, and having the knowledge and capacity to provide informed consent [1, 3, 4]. A recent review of bariatric surgery in children and adolescents examined 23 studies with a total of 637 patients and a mean age in the combined studies of 16.6 years [5]. The majority were within a few years of their 18th birthdays, where full physical maturity, greater mental maturity, and personal autonomy and independence are reached. BWhy not wait a year or two?^ may be considered a logical approach by those opposed to bariatric surgery in adolescents. However, such an approach neglects those with serious medical issues that may be associated with rapid deterioration, end-organ damage, and serious complications. These include, but are not limited to, type-2 diabetes, nonalcoholic steatohepatitis with fibrosis, benign intracranial hypertension, obesity hypoventilation syndrome or severe obstructive sleep apnoea [3]. Clearly, there are medical cases where early surgical intervention may well be warranted. However, serious psychological comorbidity or other conditions impacting on the adolescents’ quality of life have been less well defined as indications for surgery [3, 6]. Major impairment in both physical and mental aspects of health-related quality of life (HRQOL) is often cited as a reason for the urgency to treat severe obesity in adolescents using surgical procedures [6–9]. Obesity-related co-morbid diseases, physical disability, and high levels of stigmatization and psychological burden generate compounding stressors that make chronic disease management in severely obese individuals challenging [10]. Yet, the data regarding the actual degree and nature of impairment in QOL among severely obese adolescents seeking surgery, and the long-term change following surgery is limited, and for some aspects changes documented following surgery have been inconclusive [11–13]. Patient reported outcomes, in particular those assessing change in HRQOL, are now recognized as fundamental in assessing bariatric surgical outcomes. The generic Short Form (SF)-36 has been the most commonly used instrument for reporting HRQOL following bariatric surgery [14]. This instrument has been validated for many conditions and age groups, including obesity in adolescents, and community norms from many countries are available, stratified for age and gender. Population surveys show that higher BMI is associated with greater impairment in physical than in mental health as indicated by domains and summary scores of the SF36 [15]. However, we have little information as to how obese adolescents score the SF-36 when compared with obese young adults and how scores for both groups compare with community norms. Is there really a pressing need to intervene with bariatric surgery in adolescents based on their healthrelated quality of life? The aim of this analysis was to examine, using the SF-36, HRQOL in obese adolescents and compare findings with
those of BMI- and gender-matched adults also seeking weight management who are 10 years and 20 years older, respectively. We hypothesized that adolescents would report similar mental HRQOL impairment to the older age groups but less physical HRQOL to older age groups.
Methods Subjects for this analysis were all BMI 30 to 60 kg/m2 and recruited for a number of intentional weight loss studies including that included bariatric surgery approved by the appropriate institutional Human Ethical Review Committees at Alfred Health and Monash University, Melbourne, Australia. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study, and there are no cases where an individual is identified requiring specific informed consent. In all studies, the SF-36 was used as part of the baseline data collection. From the complete preintervention study data set, we matched each of the 81 adolescents (the only available), defined as recruited and assessed before their 19th birthday, with two other subjects (from larger cohorts) matched for BMI and gender 10 and 20 years older, respectively. The Australian version of the SF-36, a 36-item instrument, was completed by each participant in a printed version. The instrument was scored in a standard manner to provide eight scale scores: physical function (PF), physical role (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role (RE), and mental health (MH); and the two summary scores of physical component summary score (PCS) and mental component summary score (MCS). These summary scores are generated to provide a mean score of 50 with a standard deviation of 10 for the general adult community [16]. For each scale, the higher the score, the better the quality of life reported. The SF-36 has been validated, and normative data for adolescents and young adults are available from Canada [17], Sweden [18], and USA [16], but there are limited data from Australia [19]. The instrument’s summary scores have also been validated and found to be suitable in morbidly obese populations [20]. The normative summary scores for the adolescent and young adult populations are shown in Table 1. It is for this reason that this HRQOL instrument allows a comparison between these age groups, and one used specifically in children and adolescents would be inappropriate. Interpretation of between-group differences can be assessed, with minimal clinically important differences (MCID) suggested to be 3.0 points for PCS and MCS scores
OBES SURG Table 1 Normative physical component summary (PCS) and mental component summary (MCS) scores for adolescent and young adult populations from the USA, Canada, Sweden, and Australia (mean±standard deviation where available)
PCS M MCS M PCS F MCS F PCS All MCS All
Age 18–24 Age 25–34 US NORMS [16]
Age 35–44
Age 16–19 Age 20–24 Canadian NORMS [17]
Age 13–15 Age 16–19 Swedish NORMS [18]
Age 20–23
53.5±6.2 50.9±8.7 53.4±8.7 47.4±11.2 53.4±7.6 49.1±10.1
52.9±7.0 51.0±8.9 51.4±8.3 48.8±9.5 52.2±7.8 49.9±9.3
53.5±6.9 49.6±9.8 53.5±5.6 49.9±7.7 – –
55.0±2.9 52.7±4.5 55.3±6.2 49.1±7.9 55.2±4.2 51.7±6.2
54.9±4.8 48.3±10.0 54.3±6.2 47.0±10.6 54.6±5.5 47.6±10.3
55.0±6.3 48.9±10.3 52.5±7.7 48.3±10.1 53.7±7.1 48.6±10.2
54.3±6.8 48.9±9.7 53.2±5.8 47.7±9.9 – –
54.8±5.5 50.5±9.7 54.2±5.5 45.7±8.3 54.6±7.6 47.0±9.0
Age 18–25 Age 26–39 Australian NORMS [19]
53.2 52.2
52.9 48.8
Full references provided in the reference list
and 5.0 points for each of the scaled scores, and/or a moderate mean difference in effect sizes of >0.5 or a threshold of 5.0 points [21]. These thresholds provide guidance only, as thresholds can vary with the nature of the population’s condition, age, gender, and baseline score. MCIDs are used for assessing change in a person’s status, but may also be used in providing a guide for assessing meaningful differences between groups. Statistical Analyses Descriptive statistics are provided for the adolescents and the two older comparator groups. The SF-36 responses were scored for the eight scale scores and two summary scores in a standard manner [16, 22]. The scale scores and summary scores were statistically compared using one-way AVOVA with the Tukey method of post hoc analysis. The KruskalWallis test was used to examine nonparametric significance, as several scale scores (RP, VT, and RE), as would be expected, were not normally distributed. Correlations between summary scores and BMI were performed using Pearson correlation coefficients with two-sided analyses. All statistical analysis was performed using IBM SPSS of Windows version 20.
Results Eighty-one obese adolescents aged between 14 and 18.8 years completed SF-36 questionnaires, and these were matched for gender and BMI 1:2 with obese adults 10 and 20 years older. The details of the three cohorts of 81 individuals and their SF-36 scale and summary scores are presented in Table 2. The groups were well matched for mean BMI, gender, and mean difference in age was very close to 10 and 20 years, respectively. Age Comparison There were statistically significant differences in excess of the proposed meaningful thresholds between the adolescent group
scores and those in their 20s for all SF-36 scale scores and summary scores, indicating greater reported impairment of all measures of HRQOL in the group in their 20s (Table 2). When those in their 30s were compared with the adolescents, the older group also reported greater impairment in most scale scores and the PCS score, but did not score significantly lower in the general health or mental health scale scores or the MCS score. In contrast, when the groups in their 20s and 30s were compared, those in their 30s had significantly better emotional role and MCS scores, and did not report any significantly greater impairment in HRQOL than those in their 20s. We were also concerned that SF-36 scores may vary with age within the adolescent group, but the scores for those above the median age of 17 years were no different to those that were younger (data not shown).
Comparison with Community Norms Comparisons with community normal values were made using only the summary scores, as they are considered the most valid and robust measures in clinically severely obese patients in the age groups of interest [20]. PCS and MCS scores for all the cohorts from the various countries and all age groups were similar and in the expected ranges, of the low 50s for PCS scores and the high 40s for MCS scores (Table 1). PCS scores for all of our three obese age groups were well below all community normal values based on both meaningful difference of >3 points and moderate between-group effect size of greater than 5 points (Fig. 1). While all groups had low PCS scores, adolescents reported statistically better PCS scores than those in their 20s and 30s. Mean MCS scores (48.5) for the adolescents were predominantly within the expected range when compared to ageequivalent community scores (range for norms: 45.7–52.7). In two cases, the 3-point difference was achieved, but there were no circumstances where a 5-point mean difference was seen. In contrast, for those in their 20s, the mean MCS score (41.9) was lower than all community norms of similar ages, and for all comparisons exceeded the clinically meaningful and
OBES SURG Table 2 Characteristics and SF36 scale and summary scores for the adolescent, 20s and 30s cohorts. Mean±SD and (95 % confidence interval) or median (IQR) are shown for each SF-36 score
Teens (n=81)
20s (n=81)
30s (n=81)
Whole group (n=243)
p value for ANOVA Kruskal-Wallis testa
Female:male Mean±SD age (years) Age range Mean BMI (kg/m2) BMI range PF
59:22 16.8±1.3 14.0–18.8 42.6±6.0 34.0–59.2 69.5±19.7a
59:22 27.0±1.8 21.5–30.0 43.2±7.0 31.9–59.9 54.9±21.9b
59:22 36.7±1.4 34.0–38.5 42.5±6.7 31.0–59.5 57.1±25.2b
177:66 26.8±8.3 14.0–38.5 42.7±6.6 31.0–59.9 60.5±23
RPa BP
(65.1, 73.9) 75 (50) 81.7±19a
(50.1, 59.8) 50 (100) 66.9±23b
(51.5, 62.7) 50 (100) 68.6±24b
(57.6, 63.5) 75 (75) 72.4±23
ORIGINAL CONTRIBUTIONS
Obese Adolescents Report Better Health-Related Quality of Life than Obese Young Adults John B. Dixon 1,3 & Toni L. Rice 1,2 & Elisabeth A. Lambert 1,2,4 & Gavin W. Lambert 2,5
# Springer Science+Business Media New York 2015
Abstract Background Impairment in health-related quality of life (HRQOL) is described as a major concern for severely obese adolescents seeking intentional weight loss. We aimed to compare HRQOL in obese adolescents seeking weight loss with body mass index (BMI)-matched younger adults and community norms. Methods Eighty-one adolescents (14–18.8 years) with BMI 30–60 kg/m2 completed the Short Form (SF)-36 prior to commencing a weight loss program. Each adolescent was matched for BMI and gender with two obese adults seeking weight loss, 10 and 20 years older, respectively. The groups were compared across all eight scale scores and mental and physical component summary scores (MCS and PCS). Summary scores were also compared to community norms. Results The adolescents had higher scores than those in their 20s for all SF-36 scales and summary scores, indicating better HRQOL. Compared with community norms, obese adolescents had lower PCS and comparable MCS scores. Both groups of adults had lower PCS scores, but MCS was lower in those in their 20s compared with both adolescents and those
* John B. Dixon [email protected] 1
Clinical Obesity Research, Baker IDI Heart & Diabetes Institute, 75 Commercial Road, PO Box 6492, Melbourne, VIC 3004, Australia
2
Human Neurotransmitters Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia
3
Primary Care Research Unit, Monash University, Melbourne, Australia
4
Department of Physiology, Monash University, Melbourne, Australia
5
Department of Medicine, Monash University, Melbourne, Australia
in their 30s. There were no gender differences in patterns of responses across the three age groups. Conclusions Obese adolescents seeking intentional weight loss have significant impairment in physical aspects of HRQOL, but self-reported mental HRQOL appears to be similar to community controls. In contrast, obese participants in their 20s report clinically significant impairment in mental HRQOL. When considering adolescents for bariatric surgery, careful assessment is needed. We need a greater understanding of the emotional distress reported by those in their 20s. Keywords Mental health . Emotional wellbeing . Teens . Bariatric surgery . Intentional weight loss
Introduction Bariatric-metabolic surgery in adolescents is controversial and raises many ethical and practical issues [1]. As an established effective therapy successfully used in adults, it should be carefully evaluated in adolescents [2]. In comparison to intensive behavioral and pharmaceutical therapies for illnesses of childhood and adolescence, bariatric–metabolic surgery has some special barriers that need to be considered: surgery of any type involves physical and physiological changes to healthy normal organs; these changes will have benefits and risks, and some risks may be specific to the age group; these changes are designed to be permanent, and the potential for reversibility of procedures varies considerably. Therefore, embarking on bariatric surgery in adolescents is a decision for life that needs to be undertaken cautiously. Guidelines for the use of bariatric surgery in adolescents are usually conservative, requiring body mass index (BMI) levels equivalent to adults or greater (equating to a larger departure from normal), major obesity-related complications,
OBES SURG
having attained or almost attained physiological maturity, having failed formally supervised lifestyle and behavioral programs, and having the knowledge and capacity to provide informed consent [1, 3, 4]. A recent review of bariatric surgery in children and adolescents examined 23 studies with a total of 637 patients and a mean age in the combined studies of 16.6 years [5]. The majority were within a few years of their 18th birthdays, where full physical maturity, greater mental maturity, and personal autonomy and independence are reached. BWhy not wait a year or two?^ may be considered a logical approach by those opposed to bariatric surgery in adolescents. However, such an approach neglects those with serious medical issues that may be associated with rapid deterioration, end-organ damage, and serious complications. These include, but are not limited to, type-2 diabetes, nonalcoholic steatohepatitis with fibrosis, benign intracranial hypertension, obesity hypoventilation syndrome or severe obstructive sleep apnoea [3]. Clearly, there are medical cases where early surgical intervention may well be warranted. However, serious psychological comorbidity or other conditions impacting on the adolescents’ quality of life have been less well defined as indications for surgery [3, 6]. Major impairment in both physical and mental aspects of health-related quality of life (HRQOL) is often cited as a reason for the urgency to treat severe obesity in adolescents using surgical procedures [6–9]. Obesity-related co-morbid diseases, physical disability, and high levels of stigmatization and psychological burden generate compounding stressors that make chronic disease management in severely obese individuals challenging [10]. Yet, the data regarding the actual degree and nature of impairment in QOL among severely obese adolescents seeking surgery, and the long-term change following surgery is limited, and for some aspects changes documented following surgery have been inconclusive [11–13]. Patient reported outcomes, in particular those assessing change in HRQOL, are now recognized as fundamental in assessing bariatric surgical outcomes. The generic Short Form (SF)-36 has been the most commonly used instrument for reporting HRQOL following bariatric surgery [14]. This instrument has been validated for many conditions and age groups, including obesity in adolescents, and community norms from many countries are available, stratified for age and gender. Population surveys show that higher BMI is associated with greater impairment in physical than in mental health as indicated by domains and summary scores of the SF36 [15]. However, we have little information as to how obese adolescents score the SF-36 when compared with obese young adults and how scores for both groups compare with community norms. Is there really a pressing need to intervene with bariatric surgery in adolescents based on their healthrelated quality of life? The aim of this analysis was to examine, using the SF-36, HRQOL in obese adolescents and compare findings with
those of BMI- and gender-matched adults also seeking weight management who are 10 years and 20 years older, respectively. We hypothesized that adolescents would report similar mental HRQOL impairment to the older age groups but less physical HRQOL to older age groups.
Methods Subjects for this analysis were all BMI 30 to 60 kg/m2 and recruited for a number of intentional weight loss studies including that included bariatric surgery approved by the appropriate institutional Human Ethical Review Committees at Alfred Health and Monash University, Melbourne, Australia. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study, and there are no cases where an individual is identified requiring specific informed consent. In all studies, the SF-36 was used as part of the baseline data collection. From the complete preintervention study data set, we matched each of the 81 adolescents (the only available), defined as recruited and assessed before their 19th birthday, with two other subjects (from larger cohorts) matched for BMI and gender 10 and 20 years older, respectively. The Australian version of the SF-36, a 36-item instrument, was completed by each participant in a printed version. The instrument was scored in a standard manner to provide eight scale scores: physical function (PF), physical role (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role (RE), and mental health (MH); and the two summary scores of physical component summary score (PCS) and mental component summary score (MCS). These summary scores are generated to provide a mean score of 50 with a standard deviation of 10 for the general adult community [16]. For each scale, the higher the score, the better the quality of life reported. The SF-36 has been validated, and normative data for adolescents and young adults are available from Canada [17], Sweden [18], and USA [16], but there are limited data from Australia [19]. The instrument’s summary scores have also been validated and found to be suitable in morbidly obese populations [20]. The normative summary scores for the adolescent and young adult populations are shown in Table 1. It is for this reason that this HRQOL instrument allows a comparison between these age groups, and one used specifically in children and adolescents would be inappropriate. Interpretation of between-group differences can be assessed, with minimal clinically important differences (MCID) suggested to be 3.0 points for PCS and MCS scores
OBES SURG Table 1 Normative physical component summary (PCS) and mental component summary (MCS) scores for adolescent and young adult populations from the USA, Canada, Sweden, and Australia (mean±standard deviation where available)
PCS M MCS M PCS F MCS F PCS All MCS All
Age 18–24 Age 25–34 US NORMS [16]
Age 35–44
Age 16–19 Age 20–24 Canadian NORMS [17]
Age 13–15 Age 16–19 Swedish NORMS [18]
Age 20–23
53.5±6.2 50.9±8.7 53.4±8.7 47.4±11.2 53.4±7.6 49.1±10.1
52.9±7.0 51.0±8.9 51.4±8.3 48.8±9.5 52.2±7.8 49.9±9.3
53.5±6.9 49.6±9.8 53.5±5.6 49.9±7.7 – –
55.0±2.9 52.7±4.5 55.3±6.2 49.1±7.9 55.2±4.2 51.7±6.2
54.9±4.8 48.3±10.0 54.3±6.2 47.0±10.6 54.6±5.5 47.6±10.3
55.0±6.3 48.9±10.3 52.5±7.7 48.3±10.1 53.7±7.1 48.6±10.2
54.3±6.8 48.9±9.7 53.2±5.8 47.7±9.9 – –
54.8±5.5 50.5±9.7 54.2±5.5 45.7±8.3 54.6±7.6 47.0±9.0
Age 18–25 Age 26–39 Australian NORMS [19]
53.2 52.2
52.9 48.8
Full references provided in the reference list
and 5.0 points for each of the scaled scores, and/or a moderate mean difference in effect sizes of >0.5 or a threshold of 5.0 points [21]. These thresholds provide guidance only, as thresholds can vary with the nature of the population’s condition, age, gender, and baseline score. MCIDs are used for assessing change in a person’s status, but may also be used in providing a guide for assessing meaningful differences between groups. Statistical Analyses Descriptive statistics are provided for the adolescents and the two older comparator groups. The SF-36 responses were scored for the eight scale scores and two summary scores in a standard manner [16, 22]. The scale scores and summary scores were statistically compared using one-way AVOVA with the Tukey method of post hoc analysis. The KruskalWallis test was used to examine nonparametric significance, as several scale scores (RP, VT, and RE), as would be expected, were not normally distributed. Correlations between summary scores and BMI were performed using Pearson correlation coefficients with two-sided analyses. All statistical analysis was performed using IBM SPSS of Windows version 20.
Results Eighty-one obese adolescents aged between 14 and 18.8 years completed SF-36 questionnaires, and these were matched for gender and BMI 1:2 with obese adults 10 and 20 years older. The details of the three cohorts of 81 individuals and their SF-36 scale and summary scores are presented in Table 2. The groups were well matched for mean BMI, gender, and mean difference in age was very close to 10 and 20 years, respectively. Age Comparison There were statistically significant differences in excess of the proposed meaningful thresholds between the adolescent group
scores and those in their 20s for all SF-36 scale scores and summary scores, indicating greater reported impairment of all measures of HRQOL in the group in their 20s (Table 2). When those in their 30s were compared with the adolescents, the older group also reported greater impairment in most scale scores and the PCS score, but did not score significantly lower in the general health or mental health scale scores or the MCS score. In contrast, when the groups in their 20s and 30s were compared, those in their 30s had significantly better emotional role and MCS scores, and did not report any significantly greater impairment in HRQOL than those in their 20s. We were also concerned that SF-36 scores may vary with age within the adolescent group, but the scores for those above the median age of 17 years were no different to those that were younger (data not shown).
Comparison with Community Norms Comparisons with community normal values were made using only the summary scores, as they are considered the most valid and robust measures in clinically severely obese patients in the age groups of interest [20]. PCS and MCS scores for all the cohorts from the various countries and all age groups were similar and in the expected ranges, of the low 50s for PCS scores and the high 40s for MCS scores (Table 1). PCS scores for all of our three obese age groups were well below all community normal values based on both meaningful difference of >3 points and moderate between-group effect size of greater than 5 points (Fig. 1). While all groups had low PCS scores, adolescents reported statistically better PCS scores than those in their 20s and 30s. Mean MCS scores (48.5) for the adolescents were predominantly within the expected range when compared to ageequivalent community scores (range for norms: 45.7–52.7). In two cases, the 3-point difference was achieved, but there were no circumstances where a 5-point mean difference was seen. In contrast, for those in their 20s, the mean MCS score (41.9) was lower than all community norms of similar ages, and for all comparisons exceeded the clinically meaningful and
OBES SURG Table 2 Characteristics and SF36 scale and summary scores for the adolescent, 20s and 30s cohorts. Mean±SD and (95 % confidence interval) or median (IQR) are shown for each SF-36 score
Teens (n=81)
20s (n=81)
30s (n=81)
Whole group (n=243)
p value for ANOVA Kruskal-Wallis testa
Female:male Mean±SD age (years) Age range Mean BMI (kg/m2) BMI range PF
59:22 16.8±1.3 14.0–18.8 42.6±6.0 34.0–59.2 69.5±19.7a
59:22 27.0±1.8 21.5–30.0 43.2±7.0 31.9–59.9 54.9±21.9b
59:22 36.7±1.4 34.0–38.5 42.5±6.7 31.0–59.5 57.1±25.2b
177:66 26.8±8.3 14.0–38.5 42.7±6.6 31.0–59.9 60.5±23
RPa BP
(65.1, 73.9) 75 (50) 81.7±19a
(50.1, 59.8) 50 (100) 66.9±23b
(51.5, 62.7) 50 (100) 68.6±24b
(57.6, 63.5) 75 (75) 72.4±23
