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Type 2 Diabetes
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Studies looking at 6 months or later time points for medication initiation are way too late; the data strongly suggest starting earlier and being more aggressive. — Stephanie Walsh, Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course · 15:25
Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course
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Stephanie Walsh, MD presents “Recurrent Obesity and Inadequate Primary Weight Loss” at the 2024 Pediatric Bariatric Surgery Update Course.
video16:14 · Feb 2024
A multidisciplinary team for adolescent bariatric surgery includes pediatric endocrinology, gastroenterology, psychology (2), exercise physiology (2), nutrition (2), and surgery. — Marc Harmon, Bariatric Surgery in the Pediatric Patient · 12:12
Bariatric Surgery in the Pediatric Patient
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An interactive discussion between Dr. Ponsky, Dr. Harmon and Dr. Inge about the role of bariatric surgery in pediatric patients. Dr. Inge is Chief of Pediatric Surgery, Akers Endowed Chair in Pediatric Surgery, and Director of Adolescent Ba
podcast49:29 · Sep 2018
Micronutrient supplementation after bariatric surgery should be taken like medicines, not like supplements, and this should be emphasized preoperatively and postoperatively. — Thomas Inge, Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course · 15:50
Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course
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Thomas Inge, MD presents on “Long Term Outcomes” at the 2024 Pediatric Bariatric Surgery Update Course.
video18:22 · Feb 2024
Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course
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Justin Ryder, MD presents “Research Hot Topics on the Horizon” at the 2024 Pediatric Bariatric Surgery Update Course.
video12:26 · Feb 2024
Medications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and higher weight regain due to medication discontinuation — Evan Nadler, Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course · 13:13
Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course
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Evan Nadler, MD presents “Clinical Controversies” including MBS for syndromic and genetic obesity, role of surgery for pediatric class I obesity at the 2024 Pediatric Bariatric Surgery Update Course.
video29:40 · Feb 2024
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Bariatric Surgery in the Pediatric Patient
Type 2 diabetes, previously called adult-onset diabetes, is now seen in children and teenagers as a complication of obesity.
epidemiologicalMarc Harmon1:44 ↗
Obstructive sleep apnea, hypertension, dyslipidemias, and cardiovascular risk factors are comorbidities now appearing in obese children.
clinicalMarc Harmon1:44 ↗
About half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery.
epidemiologicalThomas Inge2:20 ↗
The success rate of non-operative weight loss falls dramatically and linearly from age 6 to 16; a severely obese teenager may have only a 1% chance of losing significant weight with lifestyle interventions.
epidemiologicalTodd Ponsky3:15 ↗
Lifestyle management research defines success as 5–10% total body weight loss, whereas bariatric surgery in teens achieves about 30% weight loss at 3–5 years.
clinicalMarc Harmon4:34 ↗
Caloric restriction is the primary mechanism for weight loss; exercise is more effective for maintaining weight loss once achieved.
clinicalTodd Ponsky5:15 ↗
Orlistat is the only FDA-approved weight-loss drug for pediatrics, causing greasy stools and achieving only about 2% weight loss.
clinicalTodd Ponsky6:21 ↗
Topiramate and phentermine, approved for adults, affect appetite and satiety pathways in teenagers identically to adults and are used off-label.
clinicalTodd Ponsky6:21 ↗
Most U.S. bariatric surgeons limit surgery to teenagers (youngest reported case age 13) to ensure physiologic maturity and avoid harm to development.
guidelineMarc Harmon7:13 ↗
A colleague in Saudi Arabia has performed weight loss surgery on children as young as 6–7 with reported good long-term results.
clinicalMarc Harmon7:13 ↗
Surgery can prevent diabetes in adolescents with elevated blood sugar who are not yet diabetic.
clinicalTodd Ponsky8:25 ↗
Adult bariatric studies show a longevity benefit for surgery in morbid obesity.
clinicalTodd Ponsky8:25 ↗
Most insurance plans covering bariatric surgery require a 6-month period of medically supervised weight loss before surgery.
guidelineTodd Ponsky10:08 ↗
Patients are put through 'surgery school' during the 6-month preoperative period to teach them about the surgery, nutrition, risks, and benefits, ensuring informed, non-coerced consent.
guidelineTodd Ponsky10:08 ↗
A multidisciplinary team for adolescent bariatric surgery includes pediatric endocrinology, gastroenterology, psychology (2), exercise physiology (2), nutrition (2), and surgery.
guidelineMarc Harmon12:12 ↗
Patients may be in a medical obesity program for 3 years before considering surgery, allowing the surgical team to build longitudinal relationships with families.
guidelineMarc Harmon12:12 ↗
Many patients who need bariatric surgery lack insurance coverage due to policy exclusions, even when surgery is medically indicated.
epidemiologicalTodd Ponsky16:09 ↗
Surgeons advocate for patients when insurance denies coverage but it is not an absolute exclusion.
guidelineTodd Ponsky16:09 ↗
Teens with chaotic lives, uncontrolled medical problems, or untreated psychiatric illness may not be ready for surgery and require preparation by the multidisciplinary team.
clinicalTodd Ponsky17:52 ↗
Syndromic obesity and monogenic obesity (single-gene mutations driving appetite) account for 6–7% of severely obese children by age 10; outcomes with bariatric surgery in this group are mixed and require further study.
clinicalMarc Harmon19:11 ↗
Roux-en-Y gastric bypass has the longest track record in adults and teenagers.
clinicalMarc Harmon19:57 ↗
Adjustable gastric band has a high reoperation rate in teenagers and adults and is no longer widely offered.
clinicalMarc Harmon19:57 ↗
Vertical sleeve gastrectomy, originally a first-stage procedure for super-obese patients, now shows good initial weight loss and comorbidity resolution at 3–4 years in adults and teens.
clinicalMarc Harmon19:57 ↗
In 2015, sleeve gastrectomy was performed in 80% of adolescent bariatric cases, gastric bypass in 20%, and virtually no bands.
epidemiologicalTodd Ponsky21:14 ↗
Sleeve gastrectomy and gastric bypass show very comparable weight loss and comorbidity resolution results in teenagers.
clinicalTodd Ponsky21:14 ↗
Gastric bypass is preferred for patients with hypothalamic obesity (e.g., post-brain tumor, pan-hypopituitarism) because sleeve and band have shown inferior weight loss in this biologically driven obesity.
clinicalTodd Ponsky22:13 ↗
Theoretical and measured risks of sleeve gastrectomy are lower than gastric bypass in teenagers and adults.
clinicalTodd Ponsky22:13 ↗
Sleeve gastrectomy is performed laparoscopically, starting 4–6 cm proximal to the pylorus, mobilizing the greater curvature to the diaphragm, and stapling along a 36–42 Fr bougie to the angle of His.
clinicalMarc Harmon23:49 ↗
A 25 cm clamp can be used to standardize sleeve geometry, ensure complete fundus mobilization, and prevent leaving excess fundus that can cause reflux.
clinicalTodd Ponsky25:58 ↗
The upper spinal firing near the GE junction is the most common site for leaks and the thinnest part of the stomach.
clinicalTodd Ponsky27:34 ↗
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