Does It Have to Be Surgery?

We last addressed this subject by asking, “Who Is Ready for Bariatric Surgery?” The same post also mentioned Dr. Pretlow’s presence and presentation at the World Obesity Federation Regional Conference in Oman. Returning from that trip he wrote,

The team at the National Diabetes & Endocrine center presented four obese kids under five years of age for my recommendations. My first question was “What happens if the parents do not give food to these kids?”

“They cry!” all the parents replied in unison. These kids had their parents well-trained. The parents are being held hostage. The bariatric surgeons at the meeting said that they had performed bariatric surgery on kids as young as seven years old.

My recommendation was simple: tough love. When kids are two, or even ten, food at such ages should be totally under the control of the parents. It’s no different than refusing food to an obese pet. It may take two or three weeks or longer for the kids to stop crying, and the parents need support during this time. But eventually the kids (and the parents) will unhook from on-demand food.

In the best-case scenario, parents will choose the W8Loss2Go program as the preferred alternative to surgery.

Medically correctable

The American Academy of Pediatrics (AAP) states, as a matter of policy, that where bariatric surgery is concerned, a medically correctable cause of obesity is a contraindication. In other words, if the problem can be solved some other way, that is a strong reason not to operate.

In October of 2019 the AAP recommended lifestyle modification treatment (eating less), which has been shown to work for at least some children, if their obesity was not extreme. As Dr. Pretlow points out, the parents or adult caregivers should, after all, be in charge of the food supply.

What about older kids, with more severe obesity? The AAP says, “No studies to date demonstrate significant and durable weight loss among youth with severe obesity.” At any time, the discussion between parents or guardians, medical personnel, and patient should be all-inclusive and very thoughtful.

There is a lot to consider — BMI status, comorbidities, developmental level, physical and psychological risks, support systems, and “the ability to understand risks and benefits and adhere to lifestyle modifications.” One aspect that seems to not receive enough attention, is that patients will need to adhere to a limited diet forever, whether or not they have the surgery.

Bringing up the age difference exposes one of the weaknesses in this area of science, a certain lack of conformity among researchers. Namely,

The term “adolescent” may be defined differently in various studies and clinical settings on the basis of age or developmental stage.

The AAP, in its policy statements, uses “pediatric” to mean anyone up to age 18, with the sub-category of adolescence being 13 to 18.

A multi-author report “outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, ‘Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity.’” Childhood Obesity News will be looking at the specifics of that document next.

Your responses and feedback are welcome!

Source: “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices,”, October 2019
Image by Mark Hills/Attribution 2.0 Generic (CC BY 2.0)

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Profiles: Kids Struggling with Weight

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

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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