Patient Selection Criteria and Evaluation

Childhood obesity surgery is performed on adolescents aged 13-18 years with a BMI ≥40 kg/m² or a BMI ≥35 kg/m² and serious comorbidities. In Turkey, an average of 50-60 adolescents are found suitable for this surgery annually, with the majority being female patients.
The evaluation process for surgical candidates includes:

• Weekly clinical assessments
• 1,200-1,500 calorie diet programme
• Daily physical activity goals
• At least 6 months of structured weight loss programme

Metabolic and Psychiatric Criteria for Surgical Eligibility

Key metabolic criteria:

• Type 2 diabetes: HbA1c > 8%
• Severe sleep apnoea: AHI > 30
• Advanced fatty liver disease
• Severe joint problems

Mild to moderate depression and anxiety are acceptable limits in psychiatric evaluation.

Surgical Techniques

Two main surgical methods are applied: Laparoscopic sleeve gastrectomy reduces the stomach volume to 100-150 ml, or Roux-en-Y gastric bypass creates a 30 ml stomach pouch and rearranges the intestinal pathway.

Postoperative Follow-up and Outcomes

The follow-up protocol includes visits every two weeks for the first 6 months, monthly for the next 6 months, and quarterly after the first year. Daily protein intake of 60-80 grams and regular vitamin supplementation are required.
Results from cases performed at five reference centres in Turkey between 2018-2023:

• Excess weight loss: 47.5% at 1 year, 65.8% at 2 years
• Type 2 diabetes remission: 85.3%
• Hypertension improvement: 74.8%
• Resolution of sleep apnoea: 89.7%