Thirty-one of the patients died within 90 days of their surgery. Based on these patients' histories, the researchers found that five characteristics increased the risk of death or complications from bariatric surgery:

• BMI (body mass index -- a calculation of weight versus height) of higher than 50. The normal range is between 18.5 and 25.
• Being male.
• Hypertension -- the condition is typically related to cardiovascular diseases, which can also increase risk.
• Pulmonary embolus [clot] risk -- if patients have had or are at risk for having a blood clot in the lung, their risk may be increased.
• Being over the age of 45.

"In using our system, each one of the five characteristics is worth one point. Those patients with a score of zero are at the least risk, while those with five points are at the highest risk," DeMaria said.

Only three of the 957 patients in the study who were classified as low-risk died -- a mortality rate of just 0.31 percent -- while 19 out of 999 (1.9 percent) medium-risk patients died. In contrast, nine out of the 119 high-risk patients died -- a mortality rate of 7.56 percent, the researchers noted.

The findings could have implications for treatment decision-making, DeMaria said.

"Many people see gastric bypass surgery as an option to use only when all other approaches to weight loss have failed," he explained. "However, our system shows that this strategy may need to be reconsidered. If patients put off surgery while they attempt other therapies that ultimately don't work, over time, they risk moving into a higher-risk category as they gain more weight, get older or develop hypertension. In these cases, delays can make surgery even riskier."

DeMaria presented the results of the study and the new scoring system at the annual meeting of the American Society for Bariatric Surgery, in San Francisco.

More information

Head to the Columbia University Department of Surgery to read more about gastric bypass surgery.

Childhood Depression and Bad Parental Habits

  A study by researchers at Columbia University in New York City reported that bad parenting may put children at a higher risk for anxiety and depression. The investigators interviewed nearly 600 parents and their children, and results showed that poor parental behaviors-like verbal abuse, inconsistent rules, parental arguments in front of children, and a lack of supervision-can all increase the chances of childhood anxiety or depression.

Surprisingly, studies show that up to 2.5 percent of young children and 8.3 percent of adolescents in the United States suffer from depression. Child psychiatrist Dr. Peter Jensen looks more closely at some of the symptoms and treatments for this difficult condition.

Q: Are there certain types of children who are more prone to depression?
We think that family history is important, so genetic factors probably play a role. But there are other factors that are also suspect. Prolonged medical illnesses might serve as a precipitant, or stress factors occurring throughout a substantial period of one's life. Some people have demonstrated that the loss of significant loved ones in early critical periods-In the first five years of life-might lead to a modest increased risk for depression. Another that is also linked to depression is substance use. Prolonged substance use is probably linked to depression as well.

Q: Do you mean substance use by the child or by the mother during pregnancy?
Both.

Q: Is depression more prevalent in girls or boys?
The prevalence of depression in boys and girls is equal prior to puberty. The rates are not particularly high-maybe 2 percent or so-in that range. But when they hit puberty, unfortunately girls really seem to blossom as far as depression is concerned. At that point it probably doubles or triples among girls, whereas the rate among boys only increases modestly. We do not know if it's due to pubertal hormones, the new stress factors that occur to girls as they reach puberty and face other responsibilities, or male/female differences in societal expectations. There are a lot of issues regarding weight concerns and body image that also might contribute.

Q: What sorts of things can parents do to recognize depression in their children?
Very young children cannot verbalize their feelings the way adolescents can. Therefore, for younger children, the parent has to observe changes in mood that are exhibited by a change in behavior: the child being more tearful, being irritable, having a sustained sadness, or a loss of interest in normal activities. These are the major signs, but there might also be vegetative or bodily changes, like changes in weight, sleeping more or sleeping less. In adolescents, all of those same things might be present. But adolescents get very good at hiding depression. Frequently we find that an adolescent can be very depressed, but feels the need to put on a show to keep up their image around their parents or their peers. The parent can have real difficulty getting any kind of inroad and talking with the adolescent to find out what is going on because the adolescent might be incommunicado and might be very depressed. But again, if it looks like the child is depressed-if there's easy, frequent irritability or tearfulness, talking about death or suicide, loss of interest in normal activities, decline in grades, staying alone in one's room for long periods of time-these would all be warning signs.

Q: If your child is diagnosed with depression, what sorts of treatment options are available?
A: Well there are two major forms of treatment. Some of the newer medications are called SSRI's. It's a fancy term, but SSRI's, antidepressants like Prozac or Zoloft, work on a different chemical in the brain than some of the older style medications. They are quite safe, and highly effective in adults. We are now seeing evidence that they appear to work now in adolescents as well. The other form of treatment that we think works well in children is something called cognitive behavior therapy, or CBT. It is a special therapy that combines the two different disciplines of behavior and cognitive therapy.

Q: What would be your advice to a parent who suspects their child might have depression?
The first thing I would do as a parent is educate yourself, and speak with a primary care provider-the child's pediatrician or adolescent medicine specialist. Frequently they will know resources within the community which can help. You need to be armed with good information about what works and what does not.