Obesity Surgery (Pediatric)

Childhood obesity has become an epidemic in the United States, posing a great health challenge to our society. Obese children and adolescents are at high risk of developing type 2 diabetes, cardiovascular disease, high blood pressure, high cholesterol, and other serious health problems. These children are also more likely to develop morbid obesity in adulthood. At UCSF, we take a comprehensive team approach to treating children and adolescents with obesity.

Weight Assessment and Non-Surgical Treatment

If your child is overweight or obese, the first step is to ask your pediatrician for a referral to the UCSF Pediatric Weight Management (WATCH) Clinic. In WATCH Clinic, your child will be evaluated and develop a plan to manage your child's weight through nutrition education and behavior modification. Please visit the Pediatric Fatty Liver & Weight Assessment Clinic website for more information.

Every effort is made to achieve weight loss non-surgically, but for some children and adolescents, medical, behavioral, and nutritional approaches to weight loss may not be enough. In these cases, the medical team may refer you and your child to see a pediatric surgeon to discuss surgical options. We will work together with you and the clinic team to tailor treatment to your child's individual needs. Due to the considerable lifestyle changes that surgery will bring about, your family and child must continue to commit to a strict program of healthy eating and exercise before he or she can be a candidate for surgery.

Surgical Treatment of Obesity

For children who meet the criteria for obesity surgery, the goal of surgery is to be a tool to assist in improving your child's health. It is important to understand that obesity surgery is not cosmetic surgery, nor is it an "easy way out." Surgery is a tool -not a cure- for sustained and effective long-term weight loss in children for whom other weight management strategies have failed.

We currently offer only one type of obesity surgery for children: laparoscopic sleeve gastrectomy. Our team does not perform gastric bypass surgery for children due to the high risk of serious complications, the irreversible nature of the procedure, and the unknown long term consequences. Laparoscopic gastric banding has been used in the past, but currently not the recommended initial surgical procedure.

If you've been referred to the Pediatric Bariatric Surgery Clinic, you will have regular joint video visit appointments with the Pediatric Bariatric Surgery team for 6-12 months. At each appointment, we will ask for current weight, discuss lifestyle changes, assess your progress, provide referrals and guidance for completion of your pre-operative checklist, and continue to address your questions. During this time, we will be working with many other departments to assess your candidacy and qualifications for surgery. At this point in the process, surgery is not definite; helping you adequately prepare for surgery is our shared goal.

Sleeve Gastrectomy

A sleeve gastrectomy, also know as a “gastric sleeve”, is a restrictive bariatric surgery where a portion of the stomach is removed, leaving a narrow, tube-shaped “sleeve”. Unlike gastric bypass, the digestive tract anatomy remains intact, so food follows the normal route through the stomach and intestines. The procedure minimizes the amount of food that can be consumed. 

Pre-Operative Checklist

1. Initial joint evaluation/appointment with Dr. Tsai or Dr. Seetharaman, and Pediatric Surgery
2. Cardiology evaluation (either EKG at PCP office or referral to cardiology with echocardiogram)
3. Pulmonology evaluation including sleep study
4. Mental health assessment (UCSF Pediatric Bariatric Surgery Mental Health Eval Guidelines PDF)
5. Gynecology appointment to discuss post operative birth control (if applicable)
6. Pre-op labs
7. Chest x-ray
8. Abdominal ultrasound
9. Pre-operative appointment with Dr. Vu and Bariatric team

*Items 6-9 will all be performed at UCSF on the day of your in person pre-operative appointment.

After completing your checklist, the Pediatric Bariatric Surgery team will review your progress to deem you an eligible candidate for surgery. We will submit the required documentation to your insurance for surgery approval. We will create and review your Post-Operative Pathway, which will be provided at your pre-operative appointment, to prepare you for your upcoming surgery.

Post Operative Care

Most patients are in the hospital for two nights after having their surgery. During this time, we will work together to provide pain control, nausea control, ensure you are maintaining hydration, and facilitating movement out of bed prior to your discharge home. You will be restricted to a liquid diet for two weeks post operatively and working with the registered dietician to advance your food intake, while maintaining protein and fluid goals. You will remain on nutritional supplements specifically made for post operative bariatric patients for the remainder of your life.

For the first 2-3 weeks after surgery, your child will be on a diet of clear liquids. He or she will then begin a soft diet, and will move on to small amounts of solid food as directed by the surgeon. Food must be chewed thoroughly, liquids should be consumed separately from solids, and each meal should consist of no more than 4-6 ounces of food. Your child will need to exercise for 30 minutes 3-6 times a week. You and your child will continue to meet with the WATCH clinic team and the surgeons after surgery.

Our Team

• Sujatha Seetharaman, MD (Peds Endocrine/Obesity Medicine)
• Patrika Tsai, MD (Peds GI/Weight management clinic)
• Lan Vu, MD (Pediatric General Surgery, Surgeon)
• Jennifer Rice, NP (Pediatric General Surgery, nurse practitioner)
• Sarah Haigh, RN (Pediatric General Surgery RN)

Helpful UCSF Numbers for Pediatric Bariatric Surgery Patients

Imaging: No appointment needed for X-Rays. Walk-in Monday-Friday, 8 am- 430 pm, located on the 1st floor near the ER. Ultrasound appointments must be scheduled ahead of time. (If your child has imaging done at another facility, expect a delay in results and recommendations. These images need to be sent to UCSF by the outside facility, or brought with you on a CD to your next appointment)

Labs: No appointment needed. Walk in after your appointment Monday thru Friday 7 am- 430 pm. Lab is located on the 3rd floor at 1825 4th Street. Take the same elevators you used for clinic today to 3rd floor and follow signs to the lab. Result time can vary on the type of test being done.