From
StayCurrentMD
Obesity: Advanced Practice Providers
Chapter 1 of 15
Case study
Introduction and Case Study: Healthcare Bias in Bariatric Surgery
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder
Lurie Children's Hospital · 6 min · Published Mar 2026
Video
AAP Policy for Adolescent Bariatric Surgery: Pediatric Obesity 2017
27 min · Published Feb 2018
Video
Traci Williams, MD - 2024 Pediatric Bariatric Surgery Update Course
19 min · Published Feb 2024
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Rapid Fire and Conclusion: Pediatric Obesity 2017
23 min · Published Feb 2018
Podcast
Bariatric Surgery in the Pediatric Patient
49 min · Published Jan 2018
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Bariatric Rapid Fire Sessions: Latest Evidence and Trends in Pediatric...
22 min · Published Jul 2017
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Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
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The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
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Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
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Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle
46 s · Published May 2026
What the experts said
Obesity is defined as BMI ≥95th percentile for age and gender; severe obesity is ≥99th percentile.
In the speaker's clinic, all patients are ≥99th percentile (severely obese) and very sick.
Obesity is not just an issue of eating less and exercising more; it involves complex gene-environment-behavior interactions.
A 12-year-old patient in the weight management program died of a heart attack.
Surgical indications include BMI ≥40 with weight-related comorbidities, physiological maturity (Tanner stage 4), commitment to evaluation, agreement to avoid pregnancy for one year post-op, and supportive family.
Contraindications include medically correctable cause of obesity, active substance abuse, tobacco use, psychiatric/medical problems impairing adherence, pregnancy, breastfeeding, and unwillingness to comply with recommendations.
RYGB creates a small (~2 oz) stomach pouch with restricted outlet, providing both restriction and malabsorption by rerouting the intestine.
The main problem with RYGB is nutritional deficiency when teens are not compliant with supplements.
Vertical sleeve gastrectomy removes the portion of stomach containing ghrelin, which helps reduce appetite.
Sleeve gastrectomy has fewer nutritional complications than RYGB and may be better for teens, though more data is needed.
The speaker's center has not placed any gastric bands due to lack of FDA approval and insurance barriers.
Teen-LABS is an NIH-NIDDK funded observational study across 5 centers, now in its 8th year, enrolling adolescents aged 13-19 undergoing bariatric surgery.
In the Teen-LABS cohort, 50% have 1-3 comorbidities, 39% have 4-5 comorbidities, and 12% have more than 6 comorbidities.
Bariatric surgery in adolescents results in significant weight loss, resolution of diabetes (no longer requiring medications), cure of sleep apnea, and improvement in dyslipidemia.
Psychological outcomes after bariatric surgery show sustained improvement: quality of life starts below that of children with cancer, then improves to better than population norms and remains elevated long-term.
Over 43 million children under age 5 are affected by obesity worldwide; 170 million under 18 worldwide.
More than one-third of children in the US are affected by obesity; 1 in 8 preschoolers are affected.
Fatty liver disease is present in 29% of children with obesity.
Dyslipidemia is present in 32% of obese children aged 5-10 years.
61% of obese 5-10 year olds have one or more cardiovascular risk factors.
25% of obese 5-10 year olds have two or more cardiovascular risk factors.
Children who are overweight or obese as preschoolers are 5 times more likely to be overweight and obese as adults.
The American Academy of Pediatrics Stage 3 recommendation is referral to a comprehensive multidisciplinary weight management center with psychologist, dietitian, exercise specialist, primary care provider, and bariatric nurse.
Stage 4 AAP recommendations include weight management plus medications, very low calorie diets, and surgery if other stages unsuccessful.
Roux-en-Y gastric bypass has been performed in adults since the 1960s and in teens since the late 1970s.
Laparoscopic adjustable gastric band is not FDA-approved for anyone under age 18.
Quality of life in children with obesity is similar to or lower than that of children with cancer.
64% of teens affected by obesity report being victims of weight-based stigmatization.
Weight-based teasing and bullying is now the number one reason for bullying among children.
Studies show dietitians have negative expectations about patients with obesity, viewing them as non-compliant and attributing obesity to emotional problems.
Psychologists assign greater pathology to patients with obesity and have lower expectations of their ability to improve.
Nurses view patients with obesity as lazy, lacking self-control, non-compliant, feel repulsed by them, and don't want to be assigned to them or touch them.
Medical students view patients with obesity as having poor self-control, being sloppy, awkward, unsuccessful, and unpleasant; these attitudes persist as they become physicians.
Using graphic or shocking language does not motivate patients to change; instead it alienates them.
Parents request avoiding stigmatizing terms like 'obese,' 'fat,' 'heavy,' 'chubby' and prefer medical terms like 'weight,' 'unhealthy weight,' 'high BMI,' 'weight problems.'
Children with obesity are chosen last as a friend, even compared to children with disabilities or children in wheelchairs.