Bariatric Surgery Referral Guidelines

The Weight-Loss Surgery Program at Children’s National Hospital helps children and adolescents who are severely obese through surgical intervention coordinated with medical management in the IDEAL clinic, or in the patient’s primary medical home. While diet and behavior changes can help some children and adolescents, many of these patients go on to become obese adults. The efficacy of diet and behavioral changes can be strengthened in some patients with surgical procedures. Weight loss through bariatric surgery is one way to treat severe obesity by producing significant weight loss, correcting obesity-related medical conditions and improving self-image and socialization.

Children’s National is the only pediatric program in the region performing weight-loss surgery.

How should I initially manage and evaluate my patient?

Patients may be referred directly to the weight loss surgery program or to our multi-disciplinary medical weight management IDEAL Clinic. The initial evaluation and management will depend on the patient and family’s interest in the multiple modalities that are available to treat obesity, but usually includes behavioral and dietary changes. Whether medications are used or whether surgery is offered is determined on a case-by-case basis.

When should I refer my patient?

Patients who wish to undergo weight-loss surgery must meet specific criteria, review with your patient if they meet the following:

Have a BMI of at least 35 with an obesity-related comorbidity of greater than 40 without a comorbidity. These criteria are the ones recommended by the National Institutes of Health. Some patients may be considered for surgery if they fall outside of these criteria, but insurance companies use the above when determining their willingness to authorize surgery.
Have a history of failed obesity treatment, including documented attempts at diet and behavioral changes.
Complete all clinically required laboratory and diagnostic tests.
Have confirmation from a psychologist or psychiatrist that he or she is sufficiently mature to comply with the clinical protocol.
Complete the follow-up visits during three years after surgery.

How can I refer my patient?

What can my patient expect from a visit to Children’s National Hospital?

The surgeon will review past medical and family history and conduct a focused medical examination. He/she will then discuss the pros and cons of bariatric surgery in general, and then in particular for the given patient. Different surgical and medical options will be discussed, and an individualized treatment plan will be provided to include the process for gaining insurance approval for bariatric surgery.