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Re: Yes, there is a place for bariatric surgery (and paediatric surgeons) in childhood obesity

Dear Editor,

I commend Dr Shield and colleagues for their 9 year-old multidisciplinary obesity service for children and adolescents and I am delighted that a bariatric surgeon is now part of the team. Longterm results are still awaited to prove the benefits of this approach to weight loss in teenagers, but short-term evidence is very promising as the authors have pointed out.

I would like to describe my experience with bariatric surgery as a 'pure' paediatric surgeon in the hope that more of my colleagues will become involved with their local childhood/adolescent obesity service. I began to attend monthly 'adult' bariatric multidisciplinary team meetings (MDTs) in my 5th year of SpR training in paediatric surgery in London. This gave me an insight into the evaluation and selection process that obese adults undergo prior to any procedure.

Since I finished my training in paediatric surgery in April last, and with the support of my senior colleagues, I have combined locum consultancy in paediatric surgery with a bariatric clinical fellow post here in London. I organise the 'adult' MDTs, assess new patients considering bariatric surgery, and follow up patients post-operatively in clinic. I have assisted with 11 bariatric procedures to date (one in a 19 year-old) and there are 2 cases per week for the forthcoming months.

I have helped to establish a group of interested professionals at St. George's to provide an adolescent obesity service much like the authors describe. I have visited the adolescent bariatric units at Cincinnati Children's hospital, New York University Medical Center and Lucille Packard Children's Hospital in Stanford. Each centre was very welcoming and helpful.

Everybody agrees that bariatric surgery should be offered to teenagers within an MDT setting. Close co-operation with an 'adult' service is essential for access to expertise and equipment. I urge paediatric surgeons to be part of this process (particularly Laparoscopists) and to attend their unit's obesity service meetings. If a service does not exist, create one!