Manish Raiji, MD - 2024 Pediatric Bariatric Surgery Update Course

In adult patient-physician relationships, the patient and physician are at the central portion of the relationship, but in pediatrics the parents and entire family unit must be included.

A 17-year-old cancer patient has a lot of influence on the decisions being made for her, unlike a neonate who has no autonomy.

The medical values of children as they become adults are influenced very heavily by their parents.

Bariatric surgery fits in the category of low-risk, high-reward procedures based on data showing procedures are safe in children with excellent outcomes.

Incapacitated adults often have a lifetime of behavior upon which surrogate decision makers can base perceived values, but none of that exists for a child.

Children on Medicare and Medicaid are up to 2 times more likely to suffer from obesity, but comprise just over a third of patients obtaining bariatric services.

There is a large mismatch between the number of bariatric centers per state versus the prevalence of obesity in those states.

Children as young as 7 or 8 years of age require assent, especially for invasive procedures.

Most guidelines suggest no age limits for the performance of bariatric surgery.

Children with intellectual and developmental delays are 1.5 to 2 times more likely to have obesity due to medications, behavioral issues, and dietary issues.

Bariatric surgery should be thought of as a very effective strategy and more as a primary intervention rather than an endpoint to a spectrum of failed other options.

Clinical practice guidelines intend to offer bariatric therapy when it's available, not when everything else has been tried.

Many referring pediatricians and families still think bariatric surgery is risky and dangerous.

Obesity disproportionately affects vulnerable populations that don't have the same kind of insurance access.

Societal bias that obesity is a personal choice is the first barrier that leads people not to seek any kind of care or treatment.

Tonsillectomy and adenoidectomy for sleep apnea is only 35% effective in kids with obesity.

ENT surgeons are now recognizing the limited effectiveness of tonsillectomy in children with obesity and sleep apnea.