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Pediatric obesity — USMLE Step 3 MCQ

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HardPediatrics (Well-child / Chronic Management)Pediatric obesityUSMLE Step 3

A 15-year-old has BMI 43 kg/m², obstructive sleep apnea requiring CPAP, and hypertension despite 10 months of family-based intensive health-behavior treatment. Pubertal development is complete. Which escalation is appropriate now?

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Correct answer: A — Refer to a pediatric metabolic and bariatric surgery program for evaluation

The best answer is “Refer to a pediatric metabolic and bariatric surgery program for evaluation”. Severe obesity with an important comorbidity despite intensive treatment meets criteria to offer surgical evaluation. Referral is not a commitment to operate; it permits multidisciplinary assessment of maturity, contraindications, informed assent, family support and long-term nutritional follow-up.

Reference: AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity: https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and