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ASMBS Pediatric Metabolic and Bariatric Surgery Guidelines, 2018

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Janey S.A. Pratt, Allen Browne, Nancy T. Browne, Matias Bruzoni, Megan Cohen, Ashish Desai, Thomas Inge, Bradley C. Linden, Samer G. Mattar, Marc Michalsky, David Podkameni, Kirk W. Reichard, Fatima Cody Stanford, Meg H. Zeller, Jeffrey Zitsman

Original languageEnglish
JournalSurgery for obesity and related diseases
E-pub ahead of print23 Mar 2018


King's Authors


The ASMBS Pediatric Committee updates their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1,387 articles and other supporting evidence through February, 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the CDC age and gender matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with Class II obesity and a co-morbidity (listed in the guidelines), or with Class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities such as depressed Health Related Quality of Life score, type 2 diabetes, obstructive sleep apnea, and non-alcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.

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