Guidelines Backlash, the Biggies — Surgery, Part 2

For all practical purposes, today’s post is also known as the Fifth Bariatric Surgery Roundup. In other words, Childhood Obesity News has looked into this subject diligently, because it is so impactful. Those who are in favor of recommending bariatric surgery at a younger age say that the longer obesity is allowed to flourish in a child, the more difficult it will be to reverse that trend and get back to a healthy weight — and that is a valid point.

Another, and even more valid point, is that non-surgical methods should be tried earlier and more earnestly. The American Academy of Pediatrics is doing the best it knows how with new recommendations for more weight-loss drugs and earlier surgery. Meanwhile, Dr. Pretlow is working toward a world where both pharmaceuticals and bariatric surgery become exceedingly rare.

Bariatric Surgery and Very Young Children
Obesity was officially defined as a disease only about 10 years ago. To leap so quickly from that, to blithely recommending life-altering surgery for kids, seems rather precipitous. Let’s quote Dr. Pretlow on this one:

If non-surgical methods were effective, then bariatric surgery would be unwarranted. Therefore, we need to figure out exactly why non-surgical methods are ineffective, and create non-surgical methods that ARE effective, like addiction-based and displacement-based methods.

Bariatric Surgery for Children
Back in 2019 when this post was published, many professionals believed that “marketing weight loss surgery to children is wrong because it is invasive and dangerous, and can irreversibly transform the metabolic system.” And many still agree. For instance, Dr. David L. Katz opined,

Epidemic childhood obesity is a cultural crisis. Turning to the literal cutting edge of biomedical advance to address it is not a solution, but an abdication.

Bariatric Surgery for Children — A Desperate Case
This post relates a disturbing story of a sleeve gastrectomy performed on a child less than a year old, and what made it particularly horrific is that it did not work, possibly because her parents continued to supply “chips, biscuits, chocolates, and ice cream.” The youngster’s stomach expanded, leading to a second sleeve gastrectomy when she was seven.

Weight-Loss Surgery and Non-Adults
Some of the difficulty with assessing the usefulness of these procedures for children lies in the disparity between different methods of defining success — for instance, measuring loss in terms of excess body weight, versus loss relative to baseline weight. Despite the uproar over the AAP’s recent endorsement of surgery for kids, it has already been employed in extreme cases for very young children for years, even in the USA.

Who Is Ready for Bariatric Surgery?
In this post, we noted how enthusiastically Saudi Arabia has embraced surgical solutions for obesity, and how the government willingly pays for it under the citizens’ standard insurance policy.

Why Operating on Children and Teens Is Okay
This post reviewed some of the history of the trend toward acceptance of bariatric surgery for children and young people. Even before the recent headline-grabbing new AAP guidelines, that organization had stated that there is “no evidence to support the application of age-based eligibility limits.”

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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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