The demographic and lifestyle characteristics of all the children and parents who participated in this study are listed in Table 1. Eighteen children were recruited to the bariatric group and 25 children who were matched for age and sex were recruited to the control group, of whom seven were excluded due to incomplete data, leaving 18 children in the control group. The median age of the children in both groups was 10.6 years, and 61% were females. The body mass index (BMI) values of all the children were in the obese range (median BMI 32.3 for the bariatric group and 28.6 for the control group). There were no group differences in mean birth weight, high-risk pregnancies, developmental delays, or previous hospitalizations, as well as in parental characteristics. However, the children in the bariatric group reported significantly more trials to lose weight in the past (72% vs. 44% for the controls, p<0.02).
Table 1. Demographic and Clinical Characteristics of the Study Children and Parents.
Characteristics
|
Bariatric group
|
Control group
|
p value
|
Children
Mean age, years (range)
|
10.6 ±3.7 (2-16)
|
10.7 ±3.5 (3.5-16)
|
NS
|
Sex (M:F)
|
7:11
|
7:11
|
NS
|
BMI
|
32.32 ± 8.55 (22.15-49)
|
28.59 ± 5.5 (20.1-40.9)
|
NS
|
Mean birth weight, gr (range)
|
3281±609 (1800-4500)
|
3091±760 (825-4200)
|
NS
|
High-risk pregnancy
|
2 (11%)
|
0 (0%)
|
NS
|
Developmental delay
|
7 (38%)
|
6 (33%)
|
NS
|
Previous hospitalization
|
4 (22%)
|
5 (28%)
|
NS
|
Previous trials to lose weight
|
13 (72%)
|
8 (44%)
|
0.02
|
Academic education – father
yes n (%)
|
7 (41%)
|
11 (61%)
|
NS
|
Academic education – mother
yes n (%)
|
9 (50%)
|
13 (76%)
|
NS
|
Divorced parents
|
3 (16.7%)
|
4 (22.2%)
|
NS
|
Healthy lifestyle - father
|
6 (33.3%)
|
9 (50%)
|
NS
|
Healthy lifestyle - mother
|
3 (17%)
|
8 (47.1%)
|
NS
|
Healthy BMI - father
|
8 (44%)
|
10 (88%)
|
NS
|
Healthy BMI - mother
|
7 (39%)
|
10 (59%)
|
NS
|
Obese family member
|
18 (100%)
|
12 (67%)
|
0.02
|
BMI, body mass index.
The responses that reflected the obese child’s perspective are given in Table 2. There were no group differences in the child's ranking of academic and social skills. The children’s reported motivation to lose weight was similar in both groups, as was their estimated body image. There was, however, a significant difference in the children's willingness to undergo a bariatric procedure: 5 (28%) of the children in the bariatric group were interested in bariatric surgery instead of a conservative approach to losing weight compared to none of the children in the control group (p<0.02).
Table 2. Children’s Psychosocial View of Themselves and Interest in Bariatric Surgery
Variable
|
Bariatric group
|
Control group
|
p value
|
Child's self-estimated body image (1-10)
|
4.63±2.6 (1-10)
|
4.93±2.3 (1-8)
|
NS
|
Child's self-estimated social functioning (1-10)
|
8.71±1.8 (5-10)
|
7.83±2.4 (3-10)
|
NS
|
Child's self-estimated academic skills (1-10)
|
8.08±2.11 (4-10)
|
6.79±1.37 (5-9)
|
NS
|
Child's self-estimated motivation to lose weight (scale 1-10)
|
8.73±1.73 (5-10)
|
8.08±1.89 (5-10)
|
NS
|
Child's interest in undergoing bariatric surgery
|
5 (28%)
|
None
|
0.02
|
Some differences were found in the parents’ psychosocial perception of their children’s weight and health-related consequences (Table 3). The parents in the bariatric group were more likely to think that the number of friends their child had was related to their child's weight (p<0.03). In addition, those parents were more likely to consider that their child’s weight played an important role in the child's self- image (p<0.03). The parents in the bariatric group were also more likely to think that their child will not attain a normal weight without an intervention (p<0.02). The parents in the bariatric group were more likely to see their child’s weight as a health problem (p<0.04). They were also more likely to fear that obesity is putting their child’s health at risk, but this difference did not reach statistical significance. The parents in both groups feared that their children will be overweight in the future, however, none of the parents’ responses indicated that they were worried about an obesity-related comorbidity.
Table 3. Parental Psychosocial and Health Consequence Perceptions
Item (answer in scale of 1-5)
|
Bariatric group*
|
Control group*
|
p value
|
My child's weight influences his/her self-image
|
4.28
|
3.67
|
0.03
|
The number of friends my child has is related to his/her weight
|
2.56
|
1.78
|
0.03
|
My child needs outside intervention in order to lose weight
|
4.39
|
3.56
|
0.02
|
Weight is determined by fate
|
2.00
|
1.82
|
NS
|
Exercising regularly is needed in order to lose weight
|
4.5
|
4.44
|
NS
|
Healthy nutrition is needed in order to lose weight
|
4.72
|
4.67
|
NS
|
My child's weight puts his/her current health at risk
|
4.06
|
2.89
|
0.04
|
My child's weight puts his/her future health at risk
|
4.89
|
3.78
|
0.07
|
I'm worried that my child will by overweight in the future.
|
4.5
|
4.11
|
NS
|
Does your child’s weight put him/her at risk of the comorbidities of obesity? YES/NO (%)
|
2 (11%)/16 (89%)
|
3 (17%)/15 (83%)
|
NS
|
*Mean values
Most of the participants agreed that overweight is not a deterministic factor: 72% of the parents in the bariatric group and 77% of the parents in the control group disagreed that weight is determined by fate. There was unanimous agreement about the parameter of lifestyle: they all responded that healthy nutrition and frequent physical activity are needed in order to lose weight.
The parental responses to the items on future intervention revealed that the parents in the bariatric group were four times more likely to think that their children will need a bariatric procedure in the future (44% vs. 11% for the controls, p<0.07). Importantly, most of the parents who underwent bariatric surgery (83%) were satisfied with the surgery, considered it successful (72%), and would have done it again (83%).