安全ネット小児病院における小児代謝肥満外科プログラムのためのマルチモーダルフレームワークを超えて

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.

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.

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.

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

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.