Forty-five healthcare professionals responded to the survey. Of the respondents, 48% were general practitioners, 17% were paediatricians, and 33% were other specialties (5 surgical consultants, 9 medical consultants, and 1 GP trainee). Sixty-four individuals accessed the survey, and 45 responses were given. All 45 respondents were unique visitors as identified by the Qualtrics online software. 22/246 (8.9%) of GPs who were approached responded to the survey and 8 of 290 (2.7%) of paediatricians responded.

Of all respondents, 46% would not refer an adolescent for bariatric surgery. Focusing on the target population of GPs and paediatricians (Fig. 1), 77% (n = 16) of GPs responded they would not consider referring an adolescent for bariatric surgery. In contrast to this, only 25% (n = 2) of paediatricians responded that they would not refer an adolescent. There was a significant difference identified between these two groups on statistical analysis (p = 0.034).

Fig. 1

Would you consider referring an adolescent for weight-loss (bariatric) surgery? (n = 30 total, 22 GPs, 8 paediatricians)

When asked for further comments about using bariatric surgery as a weight management tool in adolescents, responses included that bariatric surgery was ‘… a relatively high-risk procedure for what is mostly a societal problem’ and that we should ‘… spend more money on prevention/education… but accept in some situations it might be needed’. Other responses ranged from ‘Should only be for adults who have failed multiple attempts at exercise/diet measures for weight reduction’ to ‘it is important for a minority of adolescents and is absolutely part of the solution for some’.

The minimum age that bariatric surgery should be considered

Most respondents (47.6% of respondents) felt that 18 years old was the minimum age above which bariatric surgery should be offered. There was no difference between girls and boys in the minimum age recommended (49% vs. 48%). Figure 2 shows the minimum age at which bariatric surgery should be considered, grouped according to GPs versus paediatricians. Most (73.6%) GPs responded that 18 years old should be the minimum age versus 25% (n = 2) of paediatricians, half of whom felt that 16 years of age is an appropriate age to consider surgery.

Fig. 2

The minimum age at which bariatric surgery should be considered in adolescents. GPs versus paediatricians

The minimum BMI where bariatric surgery should be considered

Figure 3b demonstrates the range of responses regarding the minimum BMI at which bariatric surgery should be considered. Among GPs, 45% (n = 10) felt that a BMI ≥ 40 kg/m2, regardless of obesity complications, should be the minimum BMI at which bariatric surgery is considered. Around a third (37.5%) of paediatricians responded that a BMI ≥ 35 kg/m2 was sufficient, and an equal number responded that a BMI ≥ 40 kg/m2 would be appropriate. A number (18%) of GPs responded that they would not consider surgery appropriate at any BMI. Figure 3a shows the minimum BMI data in GPs and paediatricians.

Fig. 3

a Minimum BMI above which bariatric surgery could be considered in an adolescent. b All respondents had a minimum BMI above which bariatric surgery could be considered for an adolescent

Minimum length of time attending weight management service and other supports

Approximately half (51%) of respondents felt that patients should attend an obesity service for at least 12 months before consideration for surgery. A small group (10%) of respondents felt 6 months was appropriate, and 38% (n = 18) suggested 18 months or more. Less than half (41%) of GPs responded that they would expect an adolescent to be in a weight management service for > 24 months.

There was broad agreement on the importance of psychological assessment and support. All paediatricians and nearly all (95.4%) GPs responded that an adolescent should have both individual counselling and family counselling before considering surgery. When asked about what further supports physicians expect to be in place, a dietician for the whole family was suggested, and the lack of such services currently was highlighted. Other prerequisites in addition to the obesity clinic were ‘supported counselling’ and ‘CBT and family education’.

General practitioners and paediatricians were divided on whether a child regularly missing school was an indication for surgery in an adolescent with a BMI ≥ 35. Half of paediatricians and 45% of GPs responded that missing school should be an indication for surgery.

Longer-term follow-up

Figure 4 outlines who GPs and paediatricians believe should follow-up adolescent patients with obesity for long-term follow-up. The majority of GPs (77.2%, n = 17) and paediatricians (62%, n = 5) responded that a specialist obesity clinic should follow-up patients long-term. Less than 10% of GPs responded that they should carry out the follow-up. There was some support (22.7%) for a shared-care clinic that included GPs. Respondents did not expect a bariatric surgeon to carry out the long-term follow-up.

Fig. 4

Who should follow-up with the patients long-term? Responses from GPs versus paediatricians

Medications

The respondents were asked what obesity medications should be made available to adolescents. The majority of GPs (55%, n = 12) and paediatricians (62.5%, n = 5) did not recommend any medication. However, GPs were more likely than paediatricians to respond that medications should be made available to adolescents for obesity management, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%) (Fig. 5). None of the respondents felt that phentermine/topiramate should be available. Some additional answers included ‘… don’t know about the evidence of their use in this age group’, ‘unsure’, ‘never considered it’ and ‘antidepressants if indicated’.

Fig. 5

What medications should be made available to adolescents for weight management? GPs versus paediatricians