Exploring trajectories of quality of life and influencing factors among adolescents after bariatric surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Jinyi ¹ , LIANG Hui ¹ , SHEN Jiajia ¹ , ZHAO Kang ² , HUA Hongxia ¹ ,  YANG Ningli ¹

1. Department of Metabolic and Bariatric Surgery, General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P. R. China;
2. School of Nursing, Nanjing Medical University, Nanjing 211166, P. R. China;

Corresponding?author：

YANG Ningli, Email: njyangningli2002@163.com

Keywords：

obesity; adolescent; quality of life; trajectory; metabolic bariatric surgery; influencing factor

DOI：

10.7507/1007-9424.202509028

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the trajectories of health-related quality of life (HRQoL) among adolescents after metabolic bariatric surgery and to identify influencing factors. Methods This retrospective cohort study included 208 adolescents who underwent metabolic bariatric surgery at the First Affiliated Hospital of Nanjing Medical University from June 2023 to December 2024. Data on quality of life were collected at baseline, 3 months, and 6 months postoperatively, along with related scale assessments at 6 months. Latent class growth modeling was applied to identify trajectory categories of quality of life. Demographic characteristics and scale points were compared across groups, and unordered multinomial logistic regression was used to analyze influencing factors. Results Three distinct HRQoL trajectories were identified by latent class growth model: low-level improvement group (102 cases, 49.0%), moderate-level stable group (74 cases, 35.6%), and high-level decline group (32 cases, 15.4%). Significant differences were observed among groups in BMI, percentage of excess weight loss (EWL%), points of body image, self-esteem, objective support, support utilization and appearance anxiety index at 6 months after operation (P<0.05). At 6 months postoperatively, patients in the low-level improvement group had the lowest BMI and the highest EWL%, along with higher body image and support utilization points. Patients in the moderate-level stable group experienced less weight reduction than those in the low-level improvement group, with only limited improvement in quality of life. Although patients in the high-level decline group initially had better preoperative quality of life, they showed the least postoperative weight loss, the lowest body image and support utilization points, and higher appearance anxiety points, with a progressive decline in quality of life. Results of unordered multinomial logistic regression analysis indicated that postoperative BMI, EWL%, points of body image, and support utilization were influencing factors associated with HRQoL trajectories (P<0.05). Conclusions Metabolic bariatric surgery improves quality of life in most adolescents, yet a subgroup experiences unfavorable trajectories. Postoperative weight loss, body image, and social support are critical determinants. Early identification and targeted interventions are needed to optimize long-term outcomes.

Citation： GUO Jinyi, LIANG Hui, SHEN Jiajia, ZHAO Kang, HUA Hongxia, YANG Ningli. Exploring trajectories of quality of life and influencing factors among adolescents after bariatric surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1120-1125. doi: 10.7507/1007-9424.202509028 Copy

1.	王兵. 全球及中國的肥胖癥流行病學現狀及趨勢. 中國普外基礎與臨床雜志, 2025, 32(6): 661-668.
2.	Leong KSW, Jayasinghe TN, Wilson BC, et al. High prevalence of undiagnosed comorbidities among adolescents with obesity. Sci Rep, 2020, 10(1): 20101. doi: 10.1038/s41598-020-76921-6.
3.	尹曉岳, 周寧, 董晗鈺, 等. 減重代謝手術治療青少年重度肥胖效果的Meta分析. 中國慢性病預防與控制, 2024, 32(1): 22-28, 33.
4.	文君君, 胡夢杰, 張鋮, 等. 青少年肥胖病人減重代謝術后短期療效分析. 腹部外科, 2023, 36(5): 365-369.
5.	Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med, 2016, 374(2): 113-123.
6.	Chahal-Kummen M, V?ge V, Kristinsson JA, et al. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis, 2023, 19(8): 819-829.
7.	Jebeile H, Cardel MI, Kyle TK, et al. Addressing psychosocial health in the treatment and care of adolescents with obesity. Obesity (Silver Spring), 2021, 29(9): 1413-1422.
8.	Guan W, Lin S, Fu Z, et al. Five-year physical and psychosocial outcomes in obese adolescents with and without metabolic bariatric surgery. J Adolesc Health, 2023, 73(4): 784-789.
9.	Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care, 2001, 39(8): 800-812.
10.	Dalaei F, de Vries CEE, Poulsen L, et al. Body contouring surgery after bariatric surgery improves long-term health-related quality of life and satisfaction with appearance: an international longitudinal cohort study using the BODY-Q. Ann Surg, 2024, 279(6): 1008-1017.
11.	Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open, 2016, 4(4): e679. doi: 10.1097/GOX.0000000000000665.
12.	吳淑寧, 王存川, 董志勇. 減重代謝手術療效評價指標體系的研究進展. 腹部外科, 2023, 36(1): 64-68.
13.	Shapurian R, Hojat M, Nayerahmadi H. Psychometric characteristics and dimensionality of a Persian version of Rosenberg Self-esteem Scale. Percept Mot Skills, 1987, 65(1): 27-34.
14.	閆艷, 謝笑春, 蓋笑松, 等. 中國大中學生的羅森伯格自尊量表測評結果. 中國心理衛生雜志, 2021, 35(10): 863-868.
15.	肖水源, 楊德森. 社會支持對身心健康的影響. 中國心理衛生雜志, 1987, (4): 183-187.
16.	Veale D, Eshkevari E, Kanakam N, et al. The Appearance Anxiety Inventory: validation of a process measure in the treatment of body dysmorphic disorder. Behav Cogn Psychother, 2014, 42(5): 605-616.
17.	羅曉紅, 鄒靜欣, 袁慧靈, 等. 青年外表焦慮量表的效度和信度. 中國心理衛生雜志, 2023, 37(5): 435-441.
18.	晏建英. 兒童生活質量普通適用核心量表4.0信度效度分析. 重慶: 重慶醫科大學, 2010.
19.	Pyykk? JE, Hinnen C, Aydin ?, et al. Attachment style and post-bariatric surgery health behaviours: the mediating role of self-esteem and health self-efficacy. BMC Psychol, 2023, 11(1): 248. doi: 10.1186/s40359-023-01273-5.
20.	姚琳, 柳清霞, 劉春霞, 等. 減重代謝術后3年內患者體重變化情況及影響因素分析. 中華肥胖與代謝病電子雜志, 2021, 7(3): 146-151.
21.	楊寧琍, 趙康, 花紅霞, 等. 袖狀胃切除術后病人體質量指數變化軌跡及其預測因素分析. 臨床外科雜志, 2022, 30(5): 475-478.
22.	趙康, 徐欣怡, 朱涵菲, 等. 減重代謝手術后1年治療效果對心理狀況的影響研究. 中國全科醫學, 2022, 25(36): 4528-4536, 4545.
23.	Megías á, González-Cutre D, Beltrán-Carrillo VJ, et al. The impact of living with morbid obesity on psychological need frustration: a study with bariatric patients. Stress Health, 2018, 34(4): 509-522.
24.	Li MK, Sathiyamoorthy T, Regina A, et al. “Your own pace, your own path”: perspectives of adolescents navigating life after bariatric surgery. Int J Obes (Lond), 2021, 45(12): 2546-2553.
25.	Gowey MA, Reiter-Purtill J, Becnel J, et al. Weight-related correlates of psychological dysregulation in adolescent and young adult (AYA) females with severe obesity. Appetite, 2016, 99: 211-218.
26.	郭晉儀, 楊寧琍, 梁輝, 等. 正念飲食干預在減重代謝術后患者中應用的效果. 中國普外基礎與臨床雜志, 2025, 32(5): 596-602.
27.	Trooboff SW, Stucke RS, Riblet NB, et al. Psychosocial outcomes following adolescent metabolic and bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2019, 29(11): 3653-3664.
28.	梁輝. 青少年肥胖病人行減重手術適應證及手術方式探討. 中國實用外科雜志, 2020, 40(4): 395-399.
29.	向燕輝, 侯榮霞. 青少年焦慮的發展軌跡: 基于混合增長模型的分析. 心理科學, 2025, 48(1): 53-63.

1. 王兵. 全球及中國的肥胖癥流行病學現狀及趨勢. 中國普外基礎與臨床雜志, 2025, 32(6): 661-668.
2. Leong KSW, Jayasinghe TN, Wilson BC, et al. High prevalence of undiagnosed comorbidities among adolescents with obesity. Sci Rep, 2020, 10(1): 20101. doi: 10.1038/s41598-020-76921-6.
3. 尹曉岳, 周寧, 董晗鈺, 等. 減重代謝手術治療青少年重度肥胖效果的Meta分析. 中國慢性病預防與控制, 2024, 32(1): 22-28, 33.
4. 文君君, 胡夢杰, 張鋮, 等. 青少年肥胖病人減重代謝術后短期療效分析. 腹部外科, 2023, 36(5): 365-369.
5. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med, 2016, 374(2): 113-123.
6. Chahal-Kummen M, V?ge V, Kristinsson JA, et al. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis, 2023, 19(8): 819-829.
7. Jebeile H, Cardel MI, Kyle TK, et al. Addressing psychosocial health in the treatment and care of adolescents with obesity. Obesity (Silver Spring), 2021, 29(9): 1413-1422.
8. Guan W, Lin S, Fu Z, et al. Five-year physical and psychosocial outcomes in obese adolescents with and without metabolic bariatric surgery. J Adolesc Health, 2023, 73(4): 784-789.
9. Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care, 2001, 39(8): 800-812.
10. Dalaei F, de Vries CEE, Poulsen L, et al. Body contouring surgery after bariatric surgery improves long-term health-related quality of life and satisfaction with appearance: an international longitudinal cohort study using the BODY-Q. Ann Surg, 2024, 279(6): 1008-1017.
11. Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open, 2016, 4(4): e679. doi: 10.1097/GOX.0000000000000665.
12. 吳淑寧, 王存川, 董志勇. 減重代謝手術療效評價指標體系的研究進展. 腹部外科, 2023, 36(1): 64-68.
13. Shapurian R, Hojat M, Nayerahmadi H. Psychometric characteristics and dimensionality of a Persian version of Rosenberg Self-esteem Scale. Percept Mot Skills, 1987, 65(1): 27-34.
14. 閆艷, 謝笑春, 蓋笑松, 等. 中國大中學生的羅森伯格自尊量表測評結果. 中國心理衛生雜志, 2021, 35(10): 863-868.
15. 肖水源, 楊德森. 社會支持對身心健康的影響. 中國心理衛生雜志, 1987, (4): 183-187.
16. Veale D, Eshkevari E, Kanakam N, et al. The Appearance Anxiety Inventory: validation of a process measure in the treatment of body dysmorphic disorder. Behav Cogn Psychother, 2014, 42(5): 605-616.
17. 羅曉紅, 鄒靜欣, 袁慧靈, 等. 青年外表焦慮量表的效度和信度. 中國心理衛生雜志, 2023, 37(5): 435-441.
18. 晏建英. 兒童生活質量普通適用核心量表4.0信度效度分析. 重慶: 重慶醫科大學, 2010.
19. Pyykk? JE, Hinnen C, Aydin ?, et al. Attachment style and post-bariatric surgery health behaviours: the mediating role of self-esteem and health self-efficacy. BMC Psychol, 2023, 11(1): 248. doi: 10.1186/s40359-023-01273-5.
20. 姚琳, 柳清霞, 劉春霞, 等. 減重代謝術后3年內患者體重變化情況及影響因素分析. 中華肥胖與代謝病電子雜志, 2021, 7(3): 146-151.
21. 楊寧琍, 趙康, 花紅霞, 等. 袖狀胃切除術后病人體質量指數變化軌跡及其預測因素分析. 臨床外科雜志, 2022, 30(5): 475-478.
22. 趙康, 徐欣怡, 朱涵菲, 等. 減重代謝手術后1年治療效果對心理狀況的影響研究. 中國全科醫學, 2022, 25(36): 4528-4536, 4545.
23. Megías á, González-Cutre D, Beltrán-Carrillo VJ, et al. The impact of living with morbid obesity on psychological need frustration: a study with bariatric patients. Stress Health, 2018, 34(4): 509-522.
24. Li MK, Sathiyamoorthy T, Regina A, et al. “Your own pace, your own path”: perspectives of adolescents navigating life after bariatric surgery. Int J Obes (Lond), 2021, 45(12): 2546-2553.
25. Gowey MA, Reiter-Purtill J, Becnel J, et al. Weight-related correlates of psychological dysregulation in adolescent and young adult (AYA) females with severe obesity. Appetite, 2016, 99: 211-218.
26. 郭晉儀, 楊寧琍, 梁輝, 等. 正念飲食干預在減重代謝術后患者中應用的效果. 中國普外基礎與臨床雜志, 2025, 32(5): 596-602.
27. Trooboff SW, Stucke RS, Riblet NB, et al. Psychosocial outcomes following adolescent metabolic and bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2019, 29(11): 3653-3664.
28. 梁輝. 青少年肥胖病人行減重手術適應證及手術方式探討. 中國實用外科雜志, 2020, 40(4): 395-399.
29. 向燕輝, 侯榮霞. 青少年焦慮的發展軌跡: 基于混合增長模型的分析. 心理科學, 2025, 48(1): 53-63.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Exploring trajectories of quality of life and influencing factors among adolescents after bariatric surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content