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Some in the field contend that outcomes similar to those of bariatric surgery can be readily achieved with clinical lifestyle counseling in teens with severe obesity. While this is theoretically possible, the research evidence does not support this viewpoint. My guess is that fewer than 1% of adolescents with class 3 obesity are able to achieve and maintain 30% or more BMI reduction for 3 years (as is the case with bariatric surgery) or demonstrate durable improvements in co-morbidities with lifestyle changes alone. My question to Dr. Inge and others is this: Acknowledging that many factors (e.g., insurance coverage, etc.) are involved, how large of a role does this attitude from providers play in explaining the low uptake of bariatric surgery in adolescents? And, what approaches should be taken to start to change the minds of pediatricians who are opposed to bariatric surgery, pharmacotherapy, and other biologically-based obesity treatments for adolescents with severe obesity?