h m c m s t b a As the epidemic of obesity in all age groups progresses nchecked, Americans are increasingly considering extreme easures to combat the known health complications of besity. Whereas nearly 31% of adults in the United States re obese [1], more than 15% of children and adolescents re obese—a prevalence that has more than tripled in the ast 2 decades [2]. Evidence from clinical trials shows that ehavioral weight management may have longer-lasting efects in children than in adults, but good long-term results re rare and are typically seen only in clinical research nvironments [3]. Behavioral and dietary approaches to reating obesity in childhood and adolescence are more ffective in persons with less extreme obesity [4,5]. Numerous important factors must be taken into considration when contemplating bariatric surgery for severe besity in adolescents. Surgical weight loss results in sigificant improvement, if not resolution, of most obesityelated comorbidities in adults [6]. Preliminary results sugest that this is also true for adolescents [7,8]. However, the aps in our knowledge of the long-term efficacy and potenial adverse consequences of dietary restriction and dereased absorption in adolescents are substantial. In addiion, the possibility of late weight regain and the potential ultigenerational consequences of severe dietary restriction uring child-bearing years suggest that considerable care nd deliberation should be applied to decision making conerning surgical weight management in the adolescent poplation.