Bariatric Surgery Candidates

Bariatric Surgery Patient Criteria

Adolescents being considered for bariatric surgery at Lucile Packard Children’s Hospital must:

Have a Body Mass Index (BMI) ≥ 40 with serious obesity-related complications (comorbidities) or have a BMI ≥ 50 with less serious comorbidities
Have participated in at least six consecutive months of medically-supervised attempts at weight management
Have attained physical maturity. This may vary depending on the severity of any comorbidities. Pediatric Weight Clinic physicians will evaluate patients to diagnose and determine the severity of comorbidities.
Demonstrate commitment to comprehensive medical and psychological evaluation before and after the surgery
Agree to avoid pregnancy for at least two years after bariatric surgery
Be capable of and willing to follow postoperative nutritional guidelines and exercise program
Provide informed consent to surgery. This means the patient understands all of the facts and risks about bariatric surgery and agrees to have the operation.
Attend four support group sessions per year

Patients should only consider bariatric surgery if they are able to commit to long-term follow up care and lifelong dietary, exercise and medical guidelines.

Insurance Coverage

Parents of prospective bariatric surgery patients should check to see if their health insurance covers the procedure. Different carriers have different coverage policies. Please contact us if you have questions about health insurance coverage.

Referral Process

If you would like to be considered for bariatric surgery, please ask your health care provider to complete our referral form (PDF). The completed form should be faxed to the Packard Children’s Hospital Referral Center at (650) 721-2884. Health care professionals can call (650) 736-2114 with questions.

Patients who meet the criteria listed above will be further evaluated at our Pediatric Weight Clinic. The clinic will help adolescents explore various weight-loss strategies.

If no other strategy proves to be effective, the Packard Children’s Hospital’s Adolescent Bariatric Board will review the patient’s case. The Board includes bariatric surgery team members and specialists who have been involved in the patient’s care. They:

Review the patient’s nutritional, medical and psychological status
Discuss the expected benefits and risks of the surgery for the patient

If the Board determines the patient is a bariatric surgery candidate, the bariatric surgeon dictates a letter of medical necessity to the patient’s insurance company. Once insurance approval is obtained, the surgery is scheduled.

Preoperative Information

Before the surgery, the patient, family, bariatric surgeon and nurse practitioner discuss:

Expected benefits
Realistic goals
Long-term consequences
Possible risks of the surgery

The nurse practitioner, nutritionist and physical therapist provide preoperative education. They review treatments, medications and dietary and activity changes that will take place after the surgery. They also remind the patient and family which medications and foods need to be stopped prior to the surgery and when.

Baseline laboratory tests, clinical consultations and diagnostic tests are also performed. The diagnostic tests include:

Blood work
Obstructive sleep apnea study
Pulmonary function test – Measures the lungs' ability to exchange oxygen and carbon dioxide
Electrocardiogram/echocardiogram to evaluate the heart's electrical activity
Child psychologist assessment
Bone age x-ray to determine if the patient is still growing
Endoscopy – A test that looks at the inside of the digestive system to check for gastroesophageal reflux