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Key Points

  1. The etiology of obesity is multifactorial.

  2. Obesity is a chronic disease with short-term and long-term medical and psychosocial morbidity.

  3. Morbid obesity may lead to shortened life expectancy.

  4. No child chooses to be obese.

  5. The obese child and adolescent are not the same as the obese adult.

  6. Medical weight loss programs are not effective.

  7. Bariatric surgery in adolescents is safe and effective.

  8. Low-risk surgical options are available and effective for the majority of obese adolescents.

  9. Weight management surgery is best practiced in collaboration with a multidisciplinary team.

  10. Individual bariatric procedures can be chosen for the individual obese adolescent.

  11. Collaborative studies are needed to advance bariatric surgery for adolescents.

Obesity is the most common medical condition of childhood. It is not a cosmetic issue, but a medical issue with serious, and potentially lifelong, health and psychosocial consequences.

American Academy of Pediatrics—June 21, 2004

Obesity is a chronic, debilitating and potentially fatal disease…

American Society of Bariatric Physicians—2004

The Problem

A side effect of the advancement in technology and progress in the standard of living is the increased percentage of children and adolescents that are defined as overweight or obese. Today one third of American children are overweight or obese; an incidence that has tripled in the last 30 years. This rise in obesity is apparent across the developing world as the availability of abundant food, control of infectious disease, improved sanitation and water supplies, environmental obesity-potentiating agents (obesogens), and decreased physical activity precede an alarming rapid rise in childhood obesity. This inconvenient truth about childhood obesity is especially pertinent for pediatric surgeons who have heretofore been able to avoid the surgical care of obese children with the occasional unsettling and perhaps, guilt-ridden transfer of a severely ill morbidly obese child to an adult bariatric surgeon for a major bariatric procedure. With the alarming increase in adolescent and childhood obesity and the unique psychosocial and medical needs of children and adolescents, it has become apparent that pediatric surgeons can no longer turn their back on this problem. It is important therefore for pediatric surgeons to have a general working knowledge of the comorbidities associated with obesity and the various surgical interventions available. Of particular importance, pediatric surgeons will care for many obese children with general surgical problems. It is important to understand the particular perioperative management issues associated with the morbidly obese child.

Pediatric health care professionals all agree that the best therapy for obesity is prevention. This in itself is no small task in our “obesogenic” society. Many different programs are underway and obesity prevention will require fundamental changes in our food supply, eating habits, sedentary lifestyles, and a realization of the dangers associated with obesity. While prevention is a laudable goal, over the last decade, leaders in pediatrics have come to the realization that something needs ...

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