Evaluation of a behavioral intervention to support adolescents undergoing bariatric surgery using the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework

Abstract

Severe obesity among adolescents in the United States is a major public health concern. While metabolic and bariatric surgery (MBS) is safe and effective for adolescents with severe obesity, no standardized lifestyle interventions are available to support MBS outcomes. TeenLyft, a 6-month behavioral support intervention adapted from the Diabetes prevention program, was provided to teens for peri-operative MBS care beginning four weeks before surgery. This study evaluated TeenLyft’s efficacy on improving weight-related behaviors using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Adolescents aged 13–18 years were recruited from a single tertiary care center MBS program. Participants enrolled in TeenLyft received online educational videos. The five RE-AIM dimensions were assessed independently using a mixed-methods approach. Data sources included baseline (pre-surgery), 3- and 6-month post-MBS follow-up data on anthropometric measures and cardiometabolic biomarkers, interviews, and electronic health records. Quantitative data provided descriptive statistics, and paired t-tests assessed within-subject changes over time to evaluate effectiveness. Qualitative data were thematically analyzed. For Reach, 76 adolescents enrolled in TeenLyft, 47 of whom did not complete MBS, and 29 (38.1%) completed MBS, with participants indicating the program structure and suitability were reasons for enrollment. In terms of effectiveness (N = 29), older age was significantly associated with greater excess weight loss (EWL > 50%: 16.8 ± 0.7 vs. 15.3 ± 1.1 years, p = 0.0083), as was female sex (p = 0.0062). As expected, weight and body mass index significantly decreased from pre-surgery to six months post-MBS (136.1 kg to 95.7 kg, p = 0.0001; BMI 48.3 to 33.3 kg/m², p = 0.0001). Adolescents reported that the program supported their physical and emotional health and wanted more mental health-related content. Adoption was influenced by clinical staff involvement in recruitment, content development, and content alignment with adolescent needs. Implementation followed the outlined protocols with some additional adaptations to boost engagement via additional social media platforms. Maintenance showed most adolescents attended follow-up clinic visits at 6- and 12-month (83% and 67% respectively). Adolescents emphasized that the program provided education and skills to support post-operative weight management. The RE-AIM framework suggested that TeenLyft was a successful approach for providing behavioral support pre-and post-MBS. Additional benefits could be bolstered with support for mental health management.

Trial Registration: NCT05393570.