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

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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. 全球及中国的肥胖症流行病学现状及趋势. 中国普外基础与临床杂志, 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.	尹晓岳, 周宁, 董晗钰, 等. 减重代谢手术治疗青少年重度肥胖效果的Meta分析. 中国慢性病预防与控制, 2024, 32(1): 22-28, 33.
4.	文君君, 胡梦杰, 张铖, 等. 青少年肥胖病人减重代谢术后短期疗效分析. 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, Våge 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.
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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.
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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.	吴淑宁, 王存川, 董志勇. 减重代谢手术疗效评价指标体系的研究进展. 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.	闫艳, 谢笑春, 盖笑松, 等. 中国大中学生的罗森伯格自尊量表测评结果. 中国心理卫生杂志, 2021, 35(10): 863-868.
15.	肖水源, 杨德森. 社会支持对身心健康的影响. 中国心理卫生杂志, 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.	罗晓红, 邹静欣, 袁慧灵, 等. 青年外表焦虑量表的效度和信度. 中国心理卫生杂志, 2023, 37(5): 435-441.
18.	晏建英. 儿童生活质量普通适用核心量表4.0信度效度分析. 重庆: 重庆医科大学, 2010.
19.	Pyykkö JE, Hinnen C, Aydin Ö, 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, 刘春霞, 等. 减重代谢术后3年内患者体重变化情况及影响因素分析. 中华肥胖与代谢病电子杂志, 2021, 7(3): 146-151.
21.	杨宁琍, 赵康, 花红霞, 等. 袖状胃切除术后病人体质量指数变化轨迹及其预测因素分析. 临床外科杂志, 2022, 30(5): 475-478.
22.	赵康, 徐欣怡, 朱涵菲, 等. 减重代谢手术后1年治疗效果对心理状况的影响研究. 中国全科医学, 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.	郭晋仪, 杨宁琍, 梁辉, 等. 正念饮食干预在减重代谢术后患者中应用的效果. 中国普外基础与临床杂志, 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.	梁辉. 青少年肥胖病人行减重手术适应证及手术方式探讨. 中国实用外科杂志, 2020, 40(4): 395-399.
29.	向燕辉, 侯荣霞. 青少年焦虑的发展轨迹: 基于混合增长模型的分析. 心理科学, 2025, 48(1): 53-63.

1. 王兵. 全球及中国的肥胖症流行病学现状及趋势. 中国普外基础与临床杂志, 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. 尹晓岳, 周宁, 董晗钰, 等. 减重代谢手术治疗青少年重度肥胖效果的Meta分析. 中国慢性病预防与控制, 2024, 32(1): 22-28, 33.
4. 文君君, 胡梦杰, 张铖, 等. 青少年肥胖病人减重代谢术后短期疗效分析. 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, Våge 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. 吴淑宁, 王存川, 董志勇. 减重代谢手术疗效评价指标体系的研究进展. 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. 闫艳, 谢笑春, 盖笑松, 等. 中国大中学生的罗森伯格自尊量表测评结果. 中国心理卫生杂志, 2021, 35(10): 863-868.
15. 肖水源, 杨德森. 社会支持对身心健康的影响. 中国心理卫生杂志, 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. 罗晓红, 邹静欣, 袁慧灵, 等. 青年外表焦虑量表的效度和信度. 中国心理卫生杂志, 2023, 37(5): 435-441.
18. 晏建英. 儿童生活质量普通适用核心量表4.0信度效度分析. 重庆: 重庆医科大学, 2010.
19. Pyykkö JE, Hinnen C, Aydin Ö, 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, 刘春霞, 等. 减重代谢术后3年内患者体重变化情况及影响因素分析. 中华肥胖与代谢病电子杂志, 2021, 7(3): 146-151.
21. 杨宁琍, 赵康, 花红霞, 等. 袖状胃切除术后病人体质量指数变化轨迹及其预测因素分析. 临床外科杂志, 2022, 30(5): 475-478.
22. 赵康, 徐欣怡, 朱涵菲, 等. 减重代谢手术后1年治疗效果对心理状况的影响研究. 中国全科医学, 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. 郭晋仪, 杨宁琍, 梁辉, 等. 正念饮食干预在减重代谢术后患者中应用的效果. 中国普外基础与临床杂志, 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. 梁辉. 青少年肥胖病人行减重手术适应证及手术方式探讨. 中国实用外科杂志, 2020, 40(4): 395-399.
29. 向燕辉, 侯荣霞. 青少年焦虑的发展轨迹: 基于混合增长模型的分析. 心理科学, 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

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