Beyond surgery: a multimodal framework for a pediatric metabolic and bariatric surgery program in a safety-net children's hospital.

BACKGROUND

Severe pediatric obesity disproportionately affects low-income and publicly insured youth, yet access to metabolic and bariatric surgery (MBS) remains limited despite clear national guidelines.

OBJECTIVES AND

SETTING

This manuscript describes the development of a pediatric MBS program within a safety-net children's hospital, using a structured framework grounded in interdisciplinary collaboration, stakeholder engagement, and a commitment to equitable access.

METHODS

Real-world clinical vignettes are used to illustrate common barriers, including delayed care, medical complexity, and systemic inequities, and to demonstrate how an integrated, adaptive approach can address these challenges. Key components of the program include multidisciplinary team development, ethical review pathways, incorporation of antiobesity medication before and after surgery, and advocacy for financial sustainability.

RESULTS

Early results suggest that this model improves access for historically excluded populations and supports safe, effective surgical care for youth with severe obesity.

CONCLUSIONS

This framework may serve as a replicable guide for other institutions (including those with diverse payor mixes) seeking to implement or expand pediatric MBS services in resource-limited or safety-net settings.