Bariatric Surgery Information for Health Care Professionals
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Note that during this expansion, routes to Packard Children’s Hospital and our outpatient clinics in Palo Alto have changed.
To refer a patient who meets the referral criteria (below) for bariatric surgery, health care providers should fill out the Pediatric Weight Clinic referral form (PDF). Please check the “bariatric surgery evaluation” box and then fax the form to the Lucile Packard Children's Hospital Referral Center at (650) 721-2884. Please call (800) 995-5724 for more information.
Parents will be asked to fill out the Parent Questionnaire (PDF) (en español) and to bring it to the first appointment.
The patient will first be seen at our Pediatric Weight Clinic.
Referral CriteriaAdolescents being considered for bariatric surgery should:
- 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 adhere to postoperative nutritional guidelines and exercise program
- Provide informed consent to surgery
- Attend four support group sessions per year
- Pseudotumor cerebri
- Non-alcoholic steatohepatitis
- Venous stasis disease
- Significant impairment in activities of daily living
- Intertriginous soft tissue infections
- Stress urinary incontinence
- Weight-related arthropathies which impair physical activity
- Obesity-related psychosocial stress