Adolescent Bariatric Surgery Pre-Operative Assessment: Real-World Practices vs. Evidence-based Assessment

Adolescent Bariatric Surgery Pre-Operative Assessment: Real-World Practices vs. Evidence-based Assessment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Adolescent Bariatric Surgery Pre-Operative Assessment: Real-World Practices vs. Evidence-based Assessment Simone Sears, Bella Braat, Eileen Chaves This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7133706/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Childhood and adolescent obesity continues to increase. From 2017-2020, the prevalence of youth obesity increased from 16.7% in 2010 to 19.7% in 2020 in the United States 1,2 . Bariatric surgery is an effective and efficacious treatment for adolescents with Class II obesity (BMI ≥ 120% to < 140% of the 95 th percentile) and Class III obesity (BMI ≥ 140% of the 95 th percentile) 3 . Key Points All surveyed adolescent bariatric psychologists reported conducting pre-surgical psychological evaluations but used differing assessment methods. Only 40% of respondents reported conducting post-operative psychological assessments, despite their importance in supporting long-term behavioral change and identifying emerging mental health concerns. Psychologists used a range of instruments—from clinical interviews to validated measures like the GAD-7 and PHQ-9—demonstrating inconsistent practices across programs. The findings underscore the importance of developing and implementing consistent, evidence-based psychological assessment guidelines to ensure comprehensive care for adolescents undergoing metabolic and bariatric surgery. Introduction Childhood and adolescent obesity continues to increase. From 2017–2020, the prevalence of youth obesity increased from 16.7% in 2010 to 19.7% in 2020 in the United States 1,2 . Bariatric surgery is an effective and efficacious treatment for adolescents with Class II obesity (BMI ≥ 120% to < 140% of the 95th percentile) and Class III obesity (BMI ≥ 140% of the 95th percentile) 3 . Pre-surgical psychological assessments help determine whether adolescents can sustain nutritional, behavioral, and physical activity changes before and after bariatric surgery. Pre-surgical psychological assessments also screen for mood and mental health conditions, which can impair an adolescent’s ability to adhere to treatment recommendations 3,4 . An extant review of the literature provides significant guidance for pre-surgical assessments in adults but is less robust for bariatric-seeking adolescents. Shapiro et al. 3 , found that 4.4% of adolescents screened in their study were eligible for MBS, yet only around 1,700 surgeries were completed annually in the U.S. This may be due to high area-level deprivation and the lack of evidence-based guidelines for adolescent bariatric psychological assessments, which are essential for identifying barriers and supporting surgical readiness 3 . The purpose of this study is to better understand real-world practices related to pre- and post-operative MBS psychological assessments in adolescents. Methods The study team conducted a cross-sectional survey of adolescent bariatric psychologists in the United States. A directory of adolescent metabolic bariatric surgery (MBS) programs was developed by expanding a partial list obtained from the American College of Surgeons (ACS). Psychologists in these programs were invited to participate in the survey through RedCap, a secure, web-based application for survey administration. Additionally, the survey was sent to pediatric obesity psychologists through the Society of Pediatric Psychology’s (SPP) Obesity SIG listserv. Psychologists were asked to respond if they conducted adolescent bariatric pre- and/or post-surgical psychological evaluations. The survey was open to participants for a period of 3 months, between July 2023 through September 2023; three reminder emails were sent out, at 3, 6 and 9 weeks after the initial invitation. The hospital’s Institutional Review Board (IRB) deemed this study as exempt. Data Analysis Descriptive statistics were used to describe the clinical demographics of the sample. See Table 1 . Table 1 Description of Clinical Sites ( N = 20) n % Patient population adolescent only 16 (80.0) adolescent and adult 4 (20.0) Family-based treatment yes 12 (60.0) no 8 (40.0) Services provided* adolescent bariatric surgery 19 (95.0) child/adolescent medical weight management 19 (95.0) adult bariatric surgery 4 (20.0) adult medical weight management 4 (20.0) Adolescent surgeries per year < 25 8 (40.0) 25–60 9 (45.0) 61–150 1 (5.0) UK 1 (5.0) N/A 1 (5.0) Adult surgeries per year 300** 1 (5.0) N/A 15 (75.0) Adolescent psychological bariatric assessments* presurgical 20 (100) postsurgical 8 (40.0) other 2 (10.0) Adult psychological bariatric assessments* presurgical 4 (20.0) postsurgical 1 (5.0) other 2 (20.0) Who completes adolescent assessments? parent or guardian 19 (95.0) child(patient) 1 (5.0) Assessment measures delivery* paper 13 (65.0) online 9 (45.0) other 4 (20.0) *Multiple answers allowed; UK = Unknown; N/A = Not applicable Results 78 adolescent bariatric centers representing 28 US states plus the District of Columbia were invited to participate. Of those, 26 respondents (33%) initiated the survey and 20 (26%) completed all responses and were included in the analyses. The size of the surgical programs varied, with some providing ≥ 25 bariatric surgeries a year (27%) and others primarily providing ≤ 25 surgeries per year (72%). Psychologists report using various validated screeners in pre-surgical assessment, with the majority using symptom-specific measures (75%), a large number (65%) using a diagnostic interview, a lower percentage using cognitive measures (25%) and a minority using only diagnostic interviews (15%), see Table 2 . The majority report utilizing pre-operative psychological assessment (100%) with the minority utilizing regular post-operative psychological assessment (20%). Pre-operative assessments most often address mood concerns, disordered eating/eating disorders, specific symptoms, and quality of life. Table 2 Pre-Surgical Assessment Measures Used Conclusion Pre- and post-operative psychological evaluations are needed to ensure that adolescents have the proper support to receive bariatric surgery 5 . Although all respondents conducted pre-surgical assessments, there was no consensus on standardized tools or domains. Some relied solely on clinical interviews, while others used multiple validated measures such as the GAD-7, PHQ-9, and Yale Food Addiction Scale. Assessment practices varied in both methods and psychological domains evaluated, including cognition, mood, and symptom-specific concerns. Only 40% of adolescent bariatric psychologist respondents reported completing post-operative assessments with patients. Post-surgical psychological assessments help ensure patients can continue to make sustained healthy lifestyle changes and identify post-surgical mental health complications. Post-surgical psychological assessments can determine if the patient is adapting well to lifestyle changes, and to treat any post-operative mental health conditions 4 . Although all respondents reported completing pre-surgical psychological assessments for pre-operative adolescent bariatric patients, the lack of consistency in real-world pre-operative assessments is apparent. Some bariatric psychologists use evidence-based diagnostic assessments, while others use only diagnostic interviews, with each respondent screening their patients using differing measures. Overall, there is a need for adolescent bariatric psychologists to follow evidence-based guidelines for psychological pre- and post-surgical assessments. Evidence-based assessment practices should be consistently employed across all adolescent bariatric psychologists to ensure those who undergo MBS are able to make necessary changes to ensure post-operative success. Declarations Informed consent was obtained from all individual participants included in the study. The authors declare that they have no conflict of interest. There was no funding provided for this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Author Contribution S.S. and B.B. wrote the key points and results sections. S.S. wrote the introduction and conclusion sections, and prepared table 2. B.B. wrote the methods section and prepared table 1. All authors reviewed and made edits to the manuscript. Data Availability Data is provided within the manuscript. References CDC. Childhood Obesity Facts [Internet]. 2024 Dec [cited 2025 Jun 6]. Available from: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Obesity in the United States, 2009– 2010 [Internet]. 2019 [cited 2025 Jun 6]. Available from: https://www.cdc.gov/nchs/products/databriefs/db82.htm Shapiro WL, Kunani P, Sidell MA, Li X, Anderson SR, Slezak JM, Koebnick C, Schwimmer JB. Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery. Pediatrics. 2024 Mar 1;153(3):e2023063916. doi : 10.1542/peds.2023-063916 . Burton ET, Mackey ER, Reynolds K, Cadieux A, Gaffka BJ, Shaffer LA. Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations. J Clin Psychol Med Settings. 2020 Jun;27(2):235–246. doi : 10.1007/s10880-020-09717-5 . Malhotra S, Czepiel KS, Akam EY, Shaw AY, Sivasubramanian R, Seetharaman S, Stanford FC. Bariatric surgery in the treatment of adolescent obesity: current perspectives in the United States. Expert Rev Endocrinol Metab. 2021 May;16(3):123–134. doi : 10.1080/17446651.2021.1914585 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 Sep, 2025 Reviews received at journal 28 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviews received at journal 21 Aug, 2025 Reviewers agreed at journal 20 Aug, 2025 Reviewers agreed at journal 10 Aug, 2025 Reviewers invited by journal 06 Aug, 2025 Editor assigned by journal 05 Aug, 2025 Submission checks completed at journal 04 Aug, 2025 First submitted to journal 15 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7133706","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":498324933,"identity":"4732d09e-b161-4a64-a05f-a0d13012b813","order_by":0,"name":"Simone Sears","email":"","orcid":"","institution":"The Ohio State University","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"","lastName":"Sears","suffix":""},{"id":498324934,"identity":"577d1ea8-611b-4532-b9ac-446e7e794024","order_by":1,"name":"Bella Braat","email":"","orcid":"","institution":"The Ohio State University","correspondingAuthor":false,"prefix":"","firstName":"Bella","middleName":"","lastName":"Braat","suffix":""},{"id":498324935,"identity":"289ad246-654b-42be-8cc0-79adfcbb1bca","order_by":2,"name":"Eileen Chaves","email":"data:image/png;base64,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","orcid":"","institution":"Nationwide Children's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Eileen","middleName":"","lastName":"Chaves","suffix":""}],"badges":[],"createdAt":"2025-07-15 19:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7133706/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7133706/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88820384,"identity":"7caf274b-2813-4200-8972-30de2c09e2f1","added_by":"auto","created_at":"2025-08-11 17:23:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":516685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7133706/v1/9cf816e9-1c6e-463d-853e-8aafed7a257e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adolescent Bariatric Surgery Pre-Operative Assessment: Real-World Practices vs. Evidence-based Assessment","fulltext":[{"header":"Key Points","content":"\u003cul\u003e\n \u003cli\u003eAll surveyed adolescent bariatric psychologists reported conducting pre-surgical psychological evaluations but used differing assessment methods.\u003c/li\u003e\n \u003cli\u003eOnly 40% of respondents reported conducting post-operative psychological assessments, despite their importance in supporting long-term behavioral change and identifying emerging mental health concerns.\u003c/li\u003e\n \u003cli\u003ePsychologists used a range of instruments\u0026mdash;from clinical interviews to validated measures like the GAD-7 and PHQ-9\u0026mdash;demonstrating inconsistent practices across programs.\u003c/li\u003e\n \u003cli\u003eThe findings underscore the importance of developing and implementing consistent, evidence-based psychological assessment guidelines to ensure comprehensive care for adolescents undergoing metabolic and bariatric surgery.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eChildhood and adolescent obesity continues to increase. From 2017–2020, the prevalence of youth obesity increased from 16.7% in 2010 to 19.7% in 2020 in the United States \u003csup\u003e1,2\u003c/sup\u003e. Bariatric surgery is an effective and efficacious treatment for adolescents with Class II obesity (BMI ≥ 120% to \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026lt;\u003c/span\u003e 140% of the 95th percentile) and Class III obesity (BMI \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e≥\u003c/span\u003e 140% of the 95th percentile)\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePre-surgical psychological assessments help determine whether adolescents can sustain nutritional, behavioral, and physical activity changes before and after bariatric surgery.\u003c/span\u003e Pre-surgical psychological assessments also screen for mood and mental health conditions, which can impair an adolescent’s ability to adhere to treatment recommendations\u003csup\u003e3,4\u003c/sup\u003e. An extant review of the literature provides significant guidance for pre-surgical assessments in adults but is less robust for bariatric-seeking adolescents. Shapiro et al.\u003csup\u003e3\u003c/sup\u003e, found that 4.4% of adolescents screened in their study were eligible for MBS, yet only around 1,700 surgeries were completed annually in the U.S. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis may be due to high area-level deprivation and the lack of evidence-based guidelines for adolescent bariatric psychological assessments, which are essential for identifying barriers and supporting surgical readiness\u003c/span\u003e\u003csup\u003e3\u003c/sup\u003e. The purpose of this study is to better understand real-world practices related to pre- and post-operative MBS psychological assessments in adolescents.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe study team conducted a cross-sectional survey of adolescent bariatric psychologists in the United States. A directory of adolescent metabolic bariatric surgery (MBS) programs was developed by expanding a partial list obtained from the American College of Surgeons (ACS).\u003c/span\u003e\u003c/p\u003e\u003cp\u003ePsychologists in these programs were invited to participate in the survey through RedCap, a secure, web-based application for survey administration. Additionally, the survey was sent to pediatric obesity psychologists through the Society of Pediatric Psychology’s (SPP) Obesity SIG listserv. Psychologists were asked to respond if they conducted adolescent bariatric pre- and/or post-surgical psychological evaluations. The survey was open to participants for a period of 3 months, between July 2023 through September 2023; three reminder emails were sent out, at 3, 6 and 9 weeks after the initial invitation. The hospital’s Institutional Review Board (IRB) deemed this study as exempt.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to describe the clinical demographics of the sample. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of Clinical Sites (\u003cem\u003eN\u003c/em\u003e = 20)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient population\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eadolescent only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(80.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eadolescent and adult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily-based treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(60.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(40.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eServices provided*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eadolescent bariatric surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(95.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003echild/adolescent medical weight management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(95.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eadult bariatric surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eadult medical weight management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdolescent surgeries per year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(40.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25–60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(45.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e61–150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdult surgeries per year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26–300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;300**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(75.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdolescent psychological bariatric assessments*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epresurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epostsurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(40.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdult psychological bariatric assessments*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epresurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epostsurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWho completes adolescent assessments?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eparent or guardian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(95.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003echild(patient)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(5.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssessment measures delivery*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epaper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(65.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eonline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(45.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Multiple answers allowed; UK = Unknown; N/A = Not applicable\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e78 adolescent bariatric centers representing 28 US states plus the District of Columbia were invited to participate. Of those, 26 respondents (33%) initiated the survey and 20 (26%) completed all responses and were included in the analyses. The size of the surgical programs varied, with some providing\u0026thinsp;\u0026ge;\u0026thinsp;25 bariatric surgeries a year (27%) and others primarily providing\u0026thinsp;\u0026le;\u0026thinsp;25 surgeries per year (72%).\u003c/p\u003e\n\u003cp\u003ePsychologists report using various validated screeners in pre-surgical assessment, with the majority using symptom-specific measures (75%), a large number (65%) using a diagnostic interview, a lower percentage using cognitive measures (25%) and a minority using only diagnostic interviews (15%), see Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The majority report utilizing pre-operative psychological assessment (100%) with the minority utilizing regular post-operative psychological assessment (20%). Pre-operative assessments most often address mood concerns, disordered eating/eating disorders, specific symptoms, and quality of life.\u003c/p\u003e\n\u003cp\u003eTable 2 Pre-Surgical Assessment Measures Used\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1754931741.png\" style=\"width: 452px;\"\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePre- and post-operative psychological evaluations are needed to ensure that adolescents have the proper support to receive bariatric surgery\u003csup\u003e5\u003c/sup\u003e. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAlthough all respondents conducted pre-surgical assessments, there was no consensus on standardized tools or domains. Some relied solely on clinical interviews, while others used multiple validated measures such as the GAD-7, PHQ-9, and Yale Food Addiction Scale. Assessment practices varied in both methods and psychological domains evaluated, including cognition, mood, and symptom-specific concerns.\u003c/span\u003e Only 40% of adolescent bariatric psychologist respondents reported completing post-operative assessments with patients. Post-surgical psychological assessments help ensure patients can continue to make sustained healthy lifestyle changes and identify post-surgical mental health complications. Post-surgical psychological assessments can determine if the patient is adapting well to lifestyle changes, and to treat any post-operative mental health conditions\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough all respondents reported completing pre-surgical psychological assessments for pre-operative adolescent bariatric patients, the lack of consistency in real-world pre-operative assessments is apparent. Some bariatric psychologists use evidence-based diagnostic assessments, while others use only diagnostic interviews, with each respondent screening their patients using differing measures. Overall, there is a need for adolescent bariatric psychologists to follow evidence-based guidelines for psychological pre- and post-surgical assessments. Evidence-based assessment practices should be consistently employed across all adolescent bariatric psychologists to ensure those who undergo MBS are able to make necessary changes to ensure post-operative success.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003cp\u003eThe authors declare that they have no conflict of interest. There was no funding provided for this study.\u003c/p\u003e\u003cp\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S. and B.B. wrote the key points and results sections. S.S. wrote the introduction and conclusion sections, and prepared table 2. B.B. wrote the methods section and prepared table 1. All authors reviewed and made edits to the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCDC. Childhood Obesity Facts [Internet]. 2024 Dec [cited 2025 Jun 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOgden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Obesity in the United States, 2009\u0026ndash; 2010 [Internet]. 2019 [cited 2025 Jun 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/products/databriefs/db82.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/products/databriefs/db82.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eShapiro WL, Kunani P, Sidell MA, Li X, Anderson SR, Slezak JM, Koebnick C, Schwimmer JB. Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery. Pediatrics. 2024 Mar 1;153(3):e2023063916. doi\u003c/span\u003e: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2023-063916\u003c/span\u003e\u003cspan address=\"10.1542/peds.2023-063916\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBurton ET, Mackey ER, Reynolds K, Cadieux A, Gaffka BJ, Shaffer LA. Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations. J Clin Psychol Med Settings. 2020 Jun;27(2):235\u0026ndash;246. doi\u003c/span\u003e: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10880-020-09717-5\u003c/span\u003e\u003cspan address=\"10.1007/s10880-020-09717-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMalhotra S, Czepiel KS, Akam EY, Shaw AY, Sivasubramanian R, Seetharaman S, Stanford FC. Bariatric surgery in the treatment of adolescent obesity: current perspectives in the United States. Expert Rev Endocrinol Metab. 2021 May;16(3):123\u0026ndash;134. doi\u003c/span\u003e: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17446651.2021.1914585\u003c/span\u003e\u003cspan address=\"10.1080/17446651.2021.1914585\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7133706/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7133706/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChildhood and adolescent obesity continues to increase.\u0026nbsp; From 2017-2020, the prevalence of youth obesity increased from 16.7% in 2010 to 19.7% in 2020 in the United States \u003csup\u003e1,2\u003c/sup\u003e.\u0026nbsp; \u0026nbsp;Bariatric surgery is an effective and efficacious treatment for adolescents with Class II obesity (BMI ≥ 120% to \u0026lt; 140% of the 95\u003csup\u003eth\u003c/sup\u003e percentile) and Class III obesity (BMI ≥ 140% of the 95\u003csup\u003eth\u003c/sup\u003e percentile)\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e","manuscriptTitle":"Adolescent Bariatric Surgery Pre-Operative Assessment: Real-World Practices vs. Evidence-based Assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 17:15:14","doi":"10.21203/rs.3.rs-7133706/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-12T09:46:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T19:01:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44105783072010845932581534023817718760","date":"2025-08-25T19:11:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T23:17:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100768878115452886515364725102555754461","date":"2025-08-21T01:03:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231032003742242001697424006690726177724","date":"2025-08-11T02:44:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-06T11:42:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T20:54:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-04T22:50:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-07-15T19:40:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"161033d7-6a12-47c3-872f-455f09d0f3df","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-12T19:08:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 17:15:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7133706","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7133706","identity":"rs-7133706","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}