This SBHC intervention showed successful recruitment and retention of participants and delivery of preventive services in both groups. Meeting with an HE did not improve BMI outcomes in the IG. Confounding factors, including sports participation and SBHC utilization, likely contributed to BMI outcomes.

Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today' s children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence. This policy statement uses the term "pediatric" in reference to a person under 18 years of age. The term "adolescent" may be defined differently in various studies and clinical settings on the basis of age or developmental stage. When making specific recommendations, this policy statement uses "adolescent" to refer to a person from age 13 years to age 18 years. "Severe" obesity (class 2 obesity or higher) is defined as having a BMI $35

Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an "epidemic within an epidemic" that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist. DEFINITION OF SEVERE OBESITY AND EPIDEMIOLOGY This technical report uses the term "pediatric" in reference to a person under 18 years of age. Although the term "adolescent" may be defined differently in various studies and clinical settings, this technical report uses "adolescent" to refer to a person aged 13 to 18 years. Although BMI percentile for age and sex is widely used to define weight status in the pediatric population regarding underweight, normal weight, overweight, and obesity, the BMI percentile, BMI z score, and several other established methods of measurement have significant limitations when applied to populations at the highest and lowest ends of the obesity spectrum. In addition, these measures often do not change greatly even when significant weight loss occurs. For these reasons, the preferred method of reporting weight status in severe obesity is as a percentage over the 95th BMI percentile for age and sex. 1 Although adults with class 2 obesity have an absolute BMI of 35 or higher, direct correlation within the pediatric population requires some additional consideration. Specifically, because BMI values increase over time from age 2 to 18 years, the use of absolute BMI is generally not considered an

Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes.