Evidence map›Paper›PMID 42277449›Full record

ArticleObesity surgery2026

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

Juan Pujol-Rafols, Daniel M Felsenreich, Júlia Carmona-Maurici, Gerhard Prager, Ricardo V Cohen, Natan Zundel, Chetan Parmar, Aayed Alqahtani, Catalin Copaescu, Pablo Omelanczuk and 13 more

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Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Juan Pujol-RafolsMetabolic and Bariatric Surgery Unit (UCOM), Hospital HM Delfos, Barcelona, Spain. juan.pujol.rafols@gmail.com.
Daniel M FelsenreichDepartment of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Viena, Austria.
Júlia Carmona-MauriciDepartament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
Gerhard PragerDepartment of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Viena, Austria.
Ricardo V CohenCenter for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil.
Natan ZundelDepartment of Surgery, University at Buffalo, Buffalo, NY, USA.
Chetan ParmarDepartment of Surgery, Whittington Hospital, University College, London, UK.
Aayed AlqahtaniNew You Medical Center, King Saud University, Obesity Chair, Riyadh, Saudi Arabia.
Catalin CopaescuDepartment of Surgery, Ponderas Academic Hospital, Bucharest, Romania.
Pablo OmelanczukDivision of Esophago-gastric and Bariatric Surgery, Hospital Italiano de Mendoza, Mendoza, Argentina.
Jacques HimpensDelta CHIREC Hospital (Belgian Registry), Brussels, Belgium.
Torsten OlbersDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Sjaak PouwelsDepartment of Surgery, University Hospital OWL of Bielefeld University - Campus Klinikum Lippe, Detmold, NRW, Germany.
Scott A ShikoraDepartment of Surgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Nicola Di LorenzoDepartment of Surgery, Sapienza University, Roma, Italy.
Maurizio de LucaDepartment of General Surgery, Rovigo Hospital, Rovigo, Italy.
Sylvia WeinerUniversity of Frankfurt, Metabolic Unit, SchifferCampus, Frankfurt, Germany.
Manuela Mazzarella. IFSO Headquarters, Naples, Italy.
Stefanie D'Arco. IFSO Headquarters, Naples, Italy.
Luigi AngrisaniPublic Health Department, School of Medicine, University Federico II of Naples, Naples, Italy.
Ozlem UyanikDepartment of General and Digestive Surgery, Hospital Consorci Alt Penedes i Garraf, Hospital Residencia Sant Camil, Sant Pere de Ribes, Barcelona, Spain.
Eva PardinaDepartament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
Jose M BalibreaEndocrine, Metabolic and Bariatric Surgery Unit. Department of Surgery. Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChildren 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. 

aimTo assess global variability in indications, practices, and healthcare coverage for pediatric MBS among IFSO member countries, and to evaluate adherence to international guidelines. 

methodA 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. 

resultsOf 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. 

conclusionDespite 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.

Indexed as

Bariatric SurgeryGuideline AdherenceObesity, MorbidPediatric ObesityPractice Guidelines as TopicPractice Patterns, Physicians'AdolescentChildGlobal HealthHumansSurveys and QuestionnairesAdolescentASMBSBariatric SurgeryChildrenCoverageGuidelinesIFSOIndicationsMetabolic SurgeryPediatric

Identifiers

PMID42277449

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.