Neurodevelopmental disorders in children and adolescents with obesity - prevalence in clinical settings and implications for adolescent bariatric surgery

Abstract

The aim of this thesis was to investigate the prevalence of neurodevelopmental disorders (NDDs), such as attention deficit/hyperactivity disorders (ADHD), in children with severe obesity, and the implications of NDDs for metabolic and bariatric surgery (MBS) in adolescence. Paper I investigated the prevalence of NDDs using screening questionnaires and clinical diagnoses in children with obesity (n=76). Paper II examined NDDs and possible associations with depression and binge eating in adolescents seeking MBS (n=48). Long-term mental health outcomes after MBS and associations with NDDs were evaluated in the surgical group (n=81) by questionnaires in Paper III and by register data compared with controls (n=80) in Paper IV. Key findings include a screening based NDD prevalence of 32% in Paper I and 54% in Paper II, and a prevalence of 32% for any clinical NDD diagnosis and 25% for ADHD in Paper IV. ADHD was not associated with reporting of depression or binge eating before MBS in Paper II and III. In Paper III, ADHD was associated with self-reported anxiety/depression and binge eating but not with weight loss at a 10-year follow-up after adolescent MBS. Weight loss was lower in the ADHD group after two and five years and a significant proportion of participants with ADHD did not attend the 10-year follow-up. In Paper IV, the risks of substance use disorders (SUD) and alcohol use disorders (AUD) was elevated after adolescent MBS compared with non-surgical controls and ADHD was linked to an even higher risk of SUD and self-harm. Conclusion: NDDs are common in children and adolescents undergoing obesity treatment. After adolescent MBS, ADHD is associated with poor long‑term mental health outcomes. The lack of an association with weight loss may reflect dropout at the 10‑year follow‑up. Risks of AUD and SUD increase after MBS, with an even higher risk of SUD in those with ADHD. Preoperative NDD screening and individualized long‑term follow‑up may improve outcomes after MBS. Further research on factors linking NDDs and obesity is crucial for prevention and treatment.