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As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths. In an effort to reduce the risk of adverse medical and psychosocial outcomes and increase compliance and follow-up monitoring after bariatric surgery, principles of adolescent growth and development, the decisional capacity of the patient, family structure, and barriers to adherence must be considered. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of [greater than or equal to]6 months of organized weight loss attempts and have met certain anthropometric, medical, and psychologic criteria. Adolescent candidates for bariatric surgery should be very severely obese (defined by the World Health Organization as a body mass index of [greater than or equal to]40), have attained a majority of skeletal maturity (generally [greater than or equal to]13 years of age for girls and [greater than or equal to]15 years of age for boys), and have comorbidities related to obesity that might be remedied with durable weight loss. Potential candidates for bariatric surgery should be referred to centers with multidisciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. Surgery should be performed in institutions that are equipped to meet the tertiary care needs of severely obese patients and to collect long-term data on the clinical outcomes of these patients. Pediatrics 2004;114:217-223; bariatric surgery, gastric bypass, adjustable gastric band, adolescence, obesity, overweight. ABBREVIATIONS. BMI, body mass index; AGB, adjustable gastric banding., In the past 30 years, the prevalence of overweight among pediatric age groups in the United States has almost tripled. Current conservative estimates indicate that 15.5% of children and adolescents [...]