# Pediatric Obesity Surgical Screener > Screen a child aged 13+ with obesity for eligibility for bariatric surgery (laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass) using the CMAJ 2025 guideline. Trigger when a clinician asks whether a child qualifies for weight loss surgery, bariatric surgery in adolescents, sleeve gastrectomy in a teenager, or when to refer for surgical management of pediatric obesity. - Skill: `dromlakhani/pediatric-obesity-surgical-screener` (Agent Skill) - Install (CLI): `npx skillmds@latest add dromlakhani/pediatric-obesity-surgical-screener` - Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/pediatric-obesity-surgical-screener/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: Coding & Dev Tools - Author: dromlakhani (https://skillmd.com/u/dromlakhani) - Updated: 2026-09-08 - Page: https://skillmd.com/skills/dromlakhani/pediatric-obesity-surgical-screener --- # Pediatric Obesity: Surgical Eligibility Screener Step-by-step checklist to determine if a child with obesity is a candidate for bariatric surgery and to guide the pre-referral workup and shared decision-making conversation. Based on CMAJ 2025 Clinical Practice Guideline (Ball et al., doi: 10.1503/cmaj.241456). --- ## Step 1 — Basic Eligibility Criteria | Criterion | Threshold | |---|---| | Age | ≥ 13 years (evidence base is exclusively ≥13) | | Obesity severity | Severe obesity confirmed by comprehensive health assessment | | Multidisciplinary team | Assessment by a **specialized multidisciplinary team** is required | | Setting | Surgical centre with paediatric bariatric program | > ⚠️ **Surgery does not require prior failure of pharmacotherapy.** Offer based on clinical severity, family preference, comorbidities, and centre availability — not as a last resort after exhausting all other options. > ⚠️ **Centres performing bariatric surgery in adolescents are limited in Canada.** Check availability in your region before raising expectations with the family. --- ## Step 2 — Comprehensive Health Assessment (4Ms) Assess all four domains before referral: ### Metabolic - Insulin resistance / type 2 diabetes - Dyslipidaemia (↑TG, ↓HDL-C, ↑LDL-C) - Hypertension - Non-alcoholic fatty liver disease (↑ALT) - Obstructive sleep apnea (consider sleep study) ### Mechanical - Musculoskeletal pain (knees, back, hips) - Mobility limitations - Exercise tolerance ### Mental Health *(critical — do not skip)* - Depression and anxiety screening - **Eating disorder screen** (binge eating disorder, atypical anorexia, purging) — **psychiatric clearance required before surgery** - Body image and self-esteem - Bullying history - Caregiver mental health ### Social Milieu - Family support and stability - Food security - Housing and neighbourhood safety - Caregiver ability to support post-operative recovery and behavioural changes - School and peer environment --- ## Step 3 — Pre-Operative Multidisciplinary Assessment The following specialists should be involved (where available): | Specialist | Role | |---|---| | Paediatric surgeon / bariatric surgeon | Surgical planning, risk stratification | | Paediatrician / obesity medicine physician | Overall obesity management | | Dietitian | Pre- and post-operative nutritional counselling | | Psychologist / psychiatrist | Mental health clearance, body image, eating disorder screen | | Social worker | Social support, family stability, access to follow-up | | Kinesiologist (where available) | Physical activity readiness | --- ## Step 4 — Surgical Options Both options are **conditional recommendations, low to moderate certainty.** Both require concurrent behavioural and psychological interventions. ### Laparoscopic Sleeve Gastrectomy (LSG) - HRQoL: **very large effect** (critically important outcome) - Weight and BMI: **substantial reduction** (very important outcome) - Anxiety and depression: **no data available** - Serious AEs: **higher incidence than non-surgical comparators** (important — discuss explicitly) - Mild-moderate AEs: higher incidence (nausea, vomiting, reflux) ### Roux-en-Y Gastric Bypass (RYGB) - HRQoL: **large effect** - Anxiety and depression: **small effect** (beneficial) - Weight and BMI: **substantial reduction** - Serious AEs: **higher incidence than non-surgical comparators** (important — discuss explicitly) - Mild-moderate AEs: higher incidence - Higher technical complexity; nutritional monitoring more intensive **Which to choose?** The guideline does not mandate one over the other — choice depends on surgical expertise, anatomical factors, patient preference, and centre experience. --- ## Step 5 — Shared Decision-Making Conversation Before referral or consent, cover explicitly: 1. **Expected benefits:** Large improvements in HRQoL and substantial weight/BMI reduction; cardiometabolic improvements likely 2. **Serious AE risk:** Higher than non-surgical management — must be disclosed; includes complications requiring hospitalisation 3. **Lifestyle commitment:** Surgery requires lifelong dietary changes, vitamin supplementation, and behavioural support 4. **No guarantee of sustained weight loss** without maintained behavioural changes 5. **Alternatives:** Confirm family has considered pharmacotherapy and intensified behavioural intervention 6. **Family/caregiver support:** Post-operative period requires strong family engagement > Involve both the child and caregivers. The child's own voice matters — especially for adolescents. --- ## Step 6 — Post-Operative Monitoring Minimum monitoring plan after surgery: | Timepoint | What to monitor | |---|---| | 1–3 months | Wound healing, GI tolerance, nutritional status, weight | | 6 months | BMIz, cardiometabolic markers, mental health screen, eating behaviours | | 12 months | HRQoL, nutritional deficiencies (iron, B12, vitamin D, calcium), weight trajectory | | Ongoing | Annual metabolic screen; eating disorder vigilance; transition to adult care planning | --- ## Clinical Guardrails - **Eating disorder is a relative contraindication** — psychiatric clearance is mandatory. Active binge eating disorder requires treatment before surgery. - **Age < 13:** Do not refer — evidence was derived exclusively from ≥13-year-olds. - **Technology-only interventions are insufficient** as a pre-operative behavioural program — ensure a proper multicomponent program is in place. - **Ongoing behavioural/psychological support post-operatively is required** — surgery alone is not adequate management. - **Transition planning:** Begin discussing adult care transition from the time of surgery, especially for 16+ year-olds. - **Lipase inhibitors:** Not a surgical alternative — do not substitute. --- ## Source CMAJ 2025 Clinical Practice Guideline: *Managing obesity in children.* Ball GDC et al. CMAJ 2025 April 14; 197:E372–89. doi: [10.1503/cmaj.241456](https://doi.org/10.1503/cmaj.241456) Updated version: June 3, 2025.