The role of metabolic and bariatric surgery in managing severe obesity in children with special health care needs and syndromic obesity.

Obesity is a growing concern in pediatric populations, with severe obesity impacting 10% of adolescents in the United States. Children and Youth with Special Healthcare Needs (CYSHCN) and those with syndromic obesity face increased risks of comorbidities, including diabetes, cardiovascular disease, and obstructive sleep apnea. Traditional interventions, such as dietary and behavioral modification, are often ineffective in these groups. The American Academy of Pediatrics now recommends treating CYSHCN similarly neurotypical children with obesity, encouraging the use of antiobesity medications and metabolic and bariatric surgery (MBS) for adolescents aged 13 and older. This review examines the outcomes of MBS in pediatric populations with special considerations, focusing on CYSHCN, those with monogenic and syndromic forms of obesity, and preteen children (<13 years of age). Laparoscopic sleeve gastrectomy results in significant weight loss and improvement in obesity-related comorbidities, with similar outcomes between neurodiverse and neurotypical patients. Additionally, emerging data suggest that MBS in children under 13 can be safe and effective when performed at specialized centers. In patients with monogenic and syndromic forms of obesity, MBS may offer long-term benefits where pharmacotherapy falls short.