Global Variability in Children and Adolescent Metabolic Bariatric Surgery Guidelines: A Worldwide IFSO Survey

Children and adolescent (pediatric) obesity is a growing global health challenge, with traditional weight-loss strategies often proving ineffective. Metabolic and bariatric surgery (MBS) is increasingly considered for pediatric patients with severe obesity. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) published its latest recommendations on pediatric MBS in 2022. However, their adoption may vary across countries due to differences in healthcare systems, cultural norms, and resources.  AIM: To assess global variability in indications, practices, and healthcare coverage for pediatric MBS among IFSO member countries, and to evaluate adherence to international guidelines.  METHOD: A descriptive survey was conducted among IFSO-affiliated national societies using a 17-item online questionnaire covering indications for pediatric MBS, recommended techniques, referral pathways, and financial coverage.  RESULTS: Of 76 societies, 66 (86.8%) responded. Most (75.8%) reported having national guidelines; 46.0% followed IFSO's BMI-based indications' criteria, while 14.0% applied stricter thresholds (BMI>40Kg/m2), and 8.0% did not recommend MBS outside clinical trials. Additionally, 31.8% required a minimum level of physical maturity on the basis of age, pubertal stage or bone growth. Sleeve gastrectomy was the most commonly recommended technique (69.2%). Pediatricians and parents were the most frequent referrers (35.0% and 33.0%, respectively). Some form of financial coverage was reported in 59.1% of countries, with significant disparities between regions.  CONCLUSION: Despite international recommendations, significant variability persists in pediatric MBS practices worldwide. Standardizing criteria and improving access to care are essential to ensure equitable and evidence-based treatment for children and adolescents with severe obesity.