Guidelines Backlash, the Biggies — Surgery, Part 3

Today’s post serves a dual purpose, being also the Sixth Bariatric Surgery Roundup. Obviously, it’s not as if weight-loss surgery for kids had never been discussed prior to the publication of new guidelines from the American Academy of Pediatrics at the beginning of this year.

Conscience and Consent
In an era when court cases about sexual reassignment surgery are being argued, bariatric surgery might seem rather tame. Still, both kinds change the body irreversibly and bring lifelong consequences.

Does It Have to Be Surgery?
Despite what may seem like a too-hearty endorsement of bariatric surgery, the AAP has always held that it would be preferable for childhood obesity to be corrected in some other way. The organization would like to emphasize this point: Surgery or no surgery, the obese patient who is serious about change will, either way, have to adhere to a limited diet forever.

Bariatric Surgery and Race
Even though minority children and teens are statistically more likely to be overweight or obese, the majority of weight-loss surgeries are performed on white patients. It seems that figuring out the reasons for this disparity might be rather important.

Evaluation for Metabolic and Bariatric Surgery
This post explains the green light, yellow light, and red light system of evaluating a surgical candidate.

Bariatric Surgery’s Progress
A major drawback is the lack of long-term followup studies. In the short term, the failure rate seems to hover around 20%. Children and teens do not even have fully-formed personalities in the first place, and they tend to emerge from major surgery with the same emotional problems that led to obesity in the first place.

Bariatric Surgery in a Less than Ideal World
A discussion of the studies that have been completed about the medical and psychosocial effects on people who had undergone bariatric surgery as children and teens. The definition of “complications” includes the need for subsequent surgeries of the same kind. Sometimes, the problem is traceable to insufficient nutrition, particularly a shortage of calcium, iron, and various vitamins. Additionally, at the two-year mark after the completion of such surgeries, it was found that almost one in five of the young patients showed signs of clinical depression. Obviously, both nutritionists and psychologists are very important members of the clinical team.

Can Best Be Improved On?
In the great majority of cases, Type 2 diabetes ceases to be a problem after bariatric surgery. The opportunity to end all that misery should thrill the fiscal conservative, because if uncorrected, all those co-morbidities will cost even more than the operations.

The Aspirations of Bariatric Surgery
Another post includes more about the multidisciplinary team concept, and includes words from Dr. Pretlow:

I’m not an advocate of bariatric surgery, particularly in the pediatric population, except for life-threatening cases. I feel strongly that overeating/obesity is an addictive process and should be treated with addiction medicine methods. Our research results support this position.

Contemplating Bariatric Surgery
This one is basically a review of a horrifying and hilarious article whose author suggests that “death on the operating table can start to sound like the best-case scenario.”

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Profiles: Kids Struggling with Weight

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The Book

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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