1. BARIATRIC SURGERY MULTIDISCIPLINARY TEAM FOCUS ON THE WHOLE PATIENT

2. TEAM  SURGEON  NUTRITIONIST  PSYCHIATRIST  GASTRO- ENTEROLGIST  ENDOCRINOLOGIST  CARDIOLOGIST  PULMONOLOGIST  ORTHOPEDIST  OPHTHALMOLOGIST  ONCOLGIST  UROLOGIST  GYNECOLOGIST  HEPATOLOGIST

3. ADDITIONAL RESEARCH SUPPORT  EPIDEMOLOGIST  STATISTICIAN  GENETICS  NEUROSCIENTIST  EXERCISE PHYSIOLOGIST  BODY COMPOSITION EXPERTS  QUALITY OF LIFE PSYCHOLOGISTS

4. LONGITUDINAL ASSESSMENT OF BARIATRIC SURGERY (LABS) 10 SURGICAL CENTERS in New York, Washington, Oregon, North Carolina, Pennsylvania, North Dakota

5. TEEN LABS  ADOLESCENTS AGES 13-17  MULTI-DESCIPLINE PEDIATRIC EXPERTISE REQUIRED AT SURGICAL CENTERS

6. ENDOCRINOLOGIST VERSUS SURGEON FOR DIABETES SURGICAL REFERRAL OF ADOLESCENTS

7. SURGERY IS EFFECTIVE  COMMUNICATION TO HEALTHCARE PROVIDERS  COMMUNICATION TO PATIENTS  REVISION OF GUIDELINES ON EVIDENCED BASED DATA TO TREAT CO-MORBIDITIES  POLICY CHANGES, eg, INSURANCE COVERAGE

8. FUTURE NEEDS  MECHANISMS OF PREVENTION TO AVOID TREATMENT  STATISTICAL MODELS OF PREVENTION  STUDIES OF FAMILY DYNAMICS AND CULTURE  EVIDENCE BASED GUIDELINES FROM EMERGING DATA.  POLICY CHANGES DIRECTED TO PREVENTION

11. Criteria for Bariatric Surgery Adolescents Being Considered for Bariatric Surgery Should: 1. Have failed 6 months of organized weight management 1. Have failed 6 months of organized weight management 2. Have attained or nearly attained physiologic maturity 2. Have attained or nearly attained physiologic maturity 3. Be very severely obese (BMI 40) with comorbidities 3. Be very severely obese (BMI 40) with comorbidities or have a BMI of 50. or have a BMI of 50. 4. Demonstrate commitment to medical and psychologic evaluations both before and after surgery 4. Demonstrate commitment to medical and psychologic evaluations both before and after surgery 5. Agree to avoid pregnancy for at least 1 year postoperatively 5. Agree to avoid pregnancy for at least 1 year postoperatively 6. Be capable of and willing to adhere to nutritional guidelines 6. Be capable of and willing to adhere to nutritional guidelines 7. Provide informed assent to surgical treatment 7. Provide informed assent to surgical treatment 8. Demonstrate decisional capacity 8. Demonstrate decisional capacity 9. Have a supportive family environment 9. Have a supportive family environment Inge 2004 Inge 2004

12. Recommendations. Surgical intervention should be adjusted to individual needs respecting maturity level and the severity of co-morbidities. A multidisciplinary team should consider the indications, contraindications, risks, and benefits of bariatric surgery for individual patients. Patients and their families to realize that bariatric surgery is not a cure for obesity but instead is an effective weight loss tool when patients comply with recommended dietary and physical activity regimens. Known risks and possible side effects of surgical procedures should be reviewed so that patients and families can participate in decision- making. Adolescent bariatric surgery should be performed only at facilities capable of treating adolescents with complications of severe obesity.