Childhood obesity: what to do, and what we will not do

Why the answer here is no

Adolescent bariatric surgery is a real and legitimate field, but it belongs in specialist paediatric centres with a paediatric endocrinologist, a psychologist, a surgeon who operates on children and a follow-up team the family can reach for the next decade. A clinic three thousand kilometres away that meets a sixteen-year-old for four days cannot provide any of that. We therefore do not operate on anyone under eighteen, and we say so at the first message rather than after a deposit.

What the growth chart says first

A child's body mass index is read as a percentile against age and sex, not as an absolute number, and a figure that would alarm you in an adult can be entirely normal at eleven. Above the ninety-fifth percentile is the definition of obesity in childhood. The first appointment belongs to a paediatrician, who will check thyroid function, insulin resistance, blood pressure and liver enzymes, and consider rarer endocrine, genetic and medication-related causes before anything else is discussed.

What actually moves the needle at home

The interventions with the best record are family-based rather than child-directed. Sugary drinks leave the house entirely, meals happen at a table rather than in front of a screen, sixty minutes of movement is built into the day, and sleep is protected at nine to eleven hours. Singling out one child for a diet while the household eats differently reliably fails. In a still-growing child, holding weight steady while height increases resolves a great deal on its own.

Where we do treat children

Parents travelling for their own sleeve often ask about a teenager at home, and the honest answer is a referral to a paediatric obesity service in their own country, which we will happily help them look for. Dentistry is different: we treat children routinely alongside their parents, in the same accredited facility and to the same standards. Saying no to one thing and yes to another is not evasion, it is the boundary of what we can do properly.

The Ones People Actually Ask.