The Evolution of Thought About Pediatric Bariatric Surgery

In early 2017, the National Law Review listed the 15 most common types of pediatric surgery. Lawyers need to know this sort of thing because…

Surgical errors occurring during these procedures may have a profound impact on the child’s physical and mental development and could severely alter his or her quality of living.

One type of pediatric surgery is bariatric, described as “a treatment for childhood obesity where a balloon is inserted into the esophagus to narrow the opening and reduce appetite.” Readers of Childhood Obesity News know there is so much more to it. A ballon is not the only option, nor was it in 2017. Staying within the same word count, it would have been much more accurate to say that there are several surgical alternatives.

It would seem important, too, for attorneys to know that bariatric surgery is not only about reducing appetite, which is so basic. Indeed, the only justification for inflicting this kind of surgery on a child is that it will prevent the degree of obesity that ushers in one or more complications, known as co-morbidities.

What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?” is a promising title, and the material lives up to it. Written by Natalie Durkin and Ashish P. Desai of King’s College Hospital, London, it begins by stating that such intervention is “still not widely accepted.” Among those in favor, the trend is\was to operate as early as possible in the child’s life. The previous year had seen the publication of two “prospective long-term outcome studies […] aiding our understanding of the efficacy and safety of bariatric surgery within the adolescent population.”

Good news, bad news

The study’s summary has two parts. First the good news:

It is increasingly clear that adolescent bariatric surgery outcomes are comparable to adults, with similar sustainable weight loss, resolution of co-morbidities and complication rates.

And the inevitable downside:

However, these studies are solely from dedicated specialist adolescent centres and results may not be reproducible if not performed in regulated environments with specialist multi-disciplinary teams.

That is a pretty big caveat. The facilities that can handle procedures of this kind are only located in major population centers, and the bills are enormous. There is a lot of prep beforehand, and eternal followups, because a lot of things can go wrong, and because there are still not enough long-term survivors to make really helpful generalizations.

Around that time, friend of the blog Amy Connor commented,

The only surgery appropriate for kids is the severance of food before it reaches the lips (of course not beyond the point of giving them adequate nutrition)… Sometimes I wonder if over eating is to compensate for a fear that they will never have enough in this crazy crazy world.

Something psychological is going on, for sure. Dr. Pretlow often wonders why the mental health professions are not taking more ownership of the obvious connection between problems that originate in the brain and the obesity epidemic.

Your responses and feedback are welcome!

Source: “15 Most Common Types of Pediatric Surgery,”, 03/13/17
Source: “What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?,”, 08/16/17
Image by Marco Verch/Attribution 2.0 Generic (CC BY 2.0)

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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