Family Perceptions of Pediatric Metabolic and Bariatric Surgery in a Safety-Net Obesity Clinic

Metabolic and bariatric surgery (MBS) is an evidence-based intervention for adolescents with severe obesity, yet uptake remains low, especially among historically underrepresented populations. This study examined perceptions of MBS among youth and their caregivers referred to a tertiary care obesity center within a large urban safety-net hospital.

Youth aged 12-18 years and their primary caregivers at a comprehensive obesity clinic completed a 22-item survey via REDCap assessing awareness, safety, perceptions, and willingness to consider surgery. Demographic and clinical data were extracted from electronic health records. Descriptive statistics, group comparisons, and multivariable regression identified factors linked to favorable MBS attitudes. Open-ended responses were analyzed using content analysis.

A total of 109 youth (median age 15.2 years [IQR: 14.3-17.2]; 62.4% female; 89.9% Hispanic; median body mass index [BMI] 37.5 kg/m² [IQR: 33.2-41.6]; median %BMI_p95 127% [IQR:112-141%]) and 95 caregivers (median age 43.7 years [IQR: 41.2-55.3]; 93.7% female; 86.3% Hispanic; median BMI 32 kg/m² [IQR: 28.2-42.2]) participated; 91 dyads completed all data. While 71% of caregivers and 56% of youth had heard of MBS as a treatment for obesity in adults, only 24% of caregivers and 15% of youth were aware of MBS as a treatment option for pediatric patients. Perceptions of safety were limited, with more than half of both caregivers and youth reporting uncertainty about the safety of MBS in children. Despite this, support for its availability was high: 79% of caregivers and 90% of youth believed that MBS should be an option for children with severe obesity when lifestyle interventions are unsuccessful. In adjusted models, caregiver history of MBS was associated with more favorable impressions of pediatric MBS among caregivers (OR = 2.86, 95% CI: 1.02-7.91, p = 0.01) and youth (OR = 2.43, 95% CI: 1.00-5.94, p < 0.05); youth impressions were also predicted by caregiver impressions (OR = 1.26, 95% CI: 1.03-1.54, p < 0.05).

Among predominantly Hispanic, publicly insured families, awareness and safety perceptions of pediatric MBS were low despite high support. Caregiver MBS experience strongly influenced attitudes, highlighting the need for culturally informed, family-centered education to improve equitable access.