Preparation of a severely obese adolescent for significant and long-term weight loss: an illustrative case.

For severely obese patients planning bariatric surgery, many surgeons advise pre-operative weight loss which can be difficult for some to achieve. We report a 16-year-old male who was referred for weight loss surgery in a very late stage of severe obesity with a weight and BMI of 310 kg and 93 kg/m(2), respectively. He also suffered from obstructive sleep apnea and hypertension. To prepare him for laparoscopic gastric bypass, a strict pre-operative nutritional intervention with inpatient and outpatient phases was designed. He lost 22 kg pre-operatively and an additional 86 kg by 67 months post-operatively, representing a 35 % total reduction in BMI. This case illustrates the feasibility and value of a defined pre-operative dietary intervention to effectively manage the weight of an adolescent referred late in the progression of severe obesity.