Bariatric Surgery Information for Health Care Professionals

How to Refer a Patient

To refer a patient who meets the referral criteria (below) for bariatric surgery, health care providers should fill out the Pediatric Weight Clinic referral form (PDF). Please check the “bariatric surgery evaluation” box and then fax the form to the Stanford Children's Health Referral Center at (650) 721-2884. Please call (650) 723-6439 for more information.

Parents will be asked to fill out the Parent Questionnaire (in English) (PDF) or Parent Questionnaire (in Spanish) (PDF) and to bring it to the first appointment.

Referral Criteria

Adolescents being considered for bariatric surgery should:

  • Have a Body Mass Index (BMI) ≥ 40 or ≥ 35 with serious obesity-related comorbidities
  • Have participated in at least six consecutive months of medically-supervised attempts at weight management
  • Have attained physical maturity. This may vary depending on the severity of any comorbidities. Pediatric Weight Clinic physicians will evaluate patients to diagnose and determine the severity of comorbidities. 
  • Demonstrate commitment to comprehensive medical and psychological evaluation before and after the surgery
  • Agree to avoid pregnancy for at least two years after bariatric surgery
  • Be capable of and willing to adhere to postoperative nutritional guidelines and exercise program
  • Provide informed consent to surgery

Comorbidities include: