Obesity: Advanced Practice Providers
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
Rapid Fire and Conclusion: Pediatric Obesity 2017
23 min · Published Feb 2018
Podcast
Bariatric Surgery in the Pediatric Patient
49 min · Published Jan 2018
Video
Bariatric Rapid Fire Sessions: Latest Evidence and Trends in Pediatric...
22 min · Published Jul 2017
Video
The Right Tool for the Job: Child & Adolescent Obesity 2015
42 min · Published Jul 2017
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Overweight is defined as ≥85th percentile for age and gender; obese as ≥95th percentile; severely obese as ≥99th percentile.
In the speaker's clinic, all patients are at or above the 99th percentile (severely obese) and are very sick.
Obesity is not just an issue of eating less and exercising more; it is a complex relationship between genes, environment, and behaviors.
Genes tell the body how to process food, when to eat, and when to move.
Every single body system is affected by obesity.
The prevalence of obesity-related comorbidities is increasing in children and adolescents; conditions normally seen in adults are now common in young children.
Over 50% of children in the clinic have cardiovascular and metabolic risk factors; 29% have fatty liver disease; 32% have dyslipidemia.
A 12-year-old patient in the weight management program died of a heart attack.
The multidisciplinary team at Children's of Alabama includes a psychologist or counselor, dietitian, physical therapist or exercise specialist, primary care provider, bariatric nurse, nurse practitioner, social worker, and surgeon.
Indications for bariatric surgery: BMI ≥40 with weight-related comorbidities, physiologic maturity (Tanner stage 4 or 5), commitment to pre- and post-operative evaluation, agreement to avoid pregnancy for one year (if female), and supportive, committed family.
Patients must demonstrate decisional capacity and maturity to give informed consent, often assessed by psychologists.
Contraindications include medically correctable cause of obesity, active substance abuse, tobacco use, medical or psychiatric problems impairing adherence, current breastfeeding, pregnancy, or plans to become pregnant within one year.
Roux-en-Y gastric bypass is the most common bariatric procedure; it is both restrictive (small pouch holds ~2 ounces) and malabsorptive (duodenum bypassed, reducing fat and sugar absorption).
Vertical sleeve gastrectomy removes a large portion of the stomach, leaving a small sleeve; the rest of the anatomy is not altered. Ghrelin (hunger hormone) is largely removed with the excised stomach.
Sleeve gastrectomy is not reversible but can be converted to gastric bypass if weight loss is inadequate or complications persist.
Laparoscopic adjustable gastric band is not FDA-approved for patients under 18 and has not been used at the speaker's center.
Teen-LABS is an NIH NIDDK-funded observational study tracking adolescents (ages 13–19) undergoing bariatric surgery to determine the risks and benefits of operating in the teen years versus waiting until adulthood.
In the Teen-LABS cohort, 50% of teens have 1–3 comorbidities, 39% have 4–5 comorbidities, and 12% have more than 6 comorbidities.
Children with obesity often do not readily disclose how badly they are being treated or how hurt they are; they will say everything is fine when it rarely is.
Psychological burdens include poor self-image, low self-worth, depression, suicidality, self-harm (cutting), and multiple suicide attempts.
School difficulties manifest as grade drops, absenteeism, withdrawal from school, or transition to homeschooling.
Bullying is severe and includes verbal abuse, food thrown at them, tripping, and exclusion; teachers may fail to stop it or may participate.
Social isolation is common; teens may not date, attend prom with a sibling or cousin, or sit on the bench in sports despite having better skills than thinner players.
Many of these children have binge eating disorders because food is their 'best friend.'
64% of teens with obesity report being victims of weight-based stigmatization; nearly every patient in the speaker's clinic reports teasing or bullying during intake.
Perpetrators of weight-based stigma include peers, teachers, parents, and healthcare professionals.
If patients seeking help detect these negative attitudes from healthcare providers, it defeats them and prevents them from moving forward.
Bariatric surgery has led to tremendous gains in the health of children: improved metabolic parameters, significant weight loss, resolution of diabetes (no longer requiring medications), cure of sleep apnea, and improved dyslipidemia.
Using graphic words to shock patients into making changes does not work; it turns them off instead.
Psychological outcomes are vastly improved after bariatric surgery; quality of life starts lower than children with cancer but becomes better than population norms and is sustained over time.
Over 43 million children under age 5 are affected by obesity worldwide; 170 million under 18 worldwide; more than one-third of US children are affected.
One in eight preschoolers in the US are already affected by obesity.
61% of obese 5- to 10-year-olds already have one or more cardiovascular risk factors; 25% have two or more.
Children who are overweight or obese as preschoolers are 5 times more likely to be overweight or obese as adults.
The American Academy of Pediatrics recommends Stage 3 care (comprehensive multidisciplinary weight management center) and Stage 4 care (intensive intervention including medications, very low calorie diets, and surgery).
Studies show children with obesity are chosen last as a friend, even compared to children with disabilities or in wheelchairs.
Quality of life for children with obesity is similar to or lower than that of children with cancer.
Weight-based discrimination may prevent acceptance to prestigious colleges or hiring for jobs, leading to lower socioeconomic status and income.
Weight is now the number one reason for teasing and bullying.
Studies show dietitians view patients with obesity negatively, expect noncompliance, and attribute obesity to emotional problems; dietetic students view these patients as ugly, insecure, and slow.
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, noncompliant, repulsive, and prefer not to be assigned to them or touch them.
Medical students view patients with obesity as having poor self-control and being sloppy, awkward, unsuccessful, and unpleasant; these attitudes persist as they become physicians.
Most healthcare professionals who work with children want to help but feel inadequate and don't know what to do.
Parents ask that providers avoid offensive words like 'obese,' 'heavy,' 'chubby,' and 'fat,' and instead use medically neutral terms like 'weight,' 'unhealthy weight,' 'high BMI,' or 'weight problems.'