Abstract

Background: Metabolic bariatric surgery is an effective treatment for adolescents with severe obesity, yet uptake remains limited. In a multidisciplinary setting where all adolescents are eligible and have access to surgery, it remains unclear which baseline characteristics are associated with undergoing surgery. This thesis examined baseline factors associated with surgical selection among adolescents with severe obesity.

Methods: A retrospective chart review was conducted among adolescents aged 12 to 18 years evaluated at a multidisciplinary pediatric obesity clinic between July 2017 and July 2024. All participants met criteria for severe obesity and completed a comprehensive baseline assessment. Adolescents were classified according to whether they eventually received surgery following an evaluation from a multidisciplinary team of healthcare professionals, creating a surgical and nonsurgical group. Baseline cardiometabolic, familial, and psychosocial variables were assessed for analysis. Group differences were assessed using independent samples tests, and logistic regression models were used to examine baseline factors associated with undergoing surgery.

Results: The final sample included 138 adolescents, of whom 27 underwent surgery and 111 who did not. Adolescents who underwent surgery had a significantly higher baseline body mass index (BMI) than those who did not. In multivariable analyses, BMI was the only factor associated with undergoing surgery across multiple models. Sex, bloodwork parameters, and psychosocial measures, including weight-related quality of life, were not independently associated with surgical selection.

Conclusion: In a multidisciplinary clinic with uniform access to surgery, baseline BMI was the primary factor associated with adolescent surgical treatment. Psychosocial and cardiometabolic measures did not independently distinguish treatment trajectories, suggesting that surgical selection in this setting is largely driven by anthropometric severity.