Shadow Me Next!

How One Surgeon Challenged the Way Childhood Obesity is Treated | Dr. Evan Nadler, MD

• Ashley Love • Season 1 • Episode 48

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A surgeon stands at a national podium, defends operating on children with severe obesity, and gets asked how he sleeps at night. Two decades later, he’s helped shape national guidelines and is building new ways for families to access care. That is what defines our candid conversation with Dr. Evan Nadler, a pioneer in pediatric bariatric surgery and a person who refuses to accept shame as a treatment plan.

We unpack how a field many didn’t know existed emerged from careful trials, relentless follow-up, and tough conversations with colleagues and parents. Dr. Nadler explains why “eat less, move more” is not a strategy but a slogan, how weight and health are not perfectly linked, and what it means to treat childhood obesity as a chronic disease with individualized options: lifestyle support, medications when appropriate, and surgery for the right patients. He shares the moment he paused a thriving surgical career to write a book, launch a telemedicine program, and scale advocacy for the 15 million children who need help now.

Access is the theme  of this story. Long waitlists and long drives leave families stranded, but a remote-first pediatric weight management model lowers barriers and personalizes care. We also talk about age cutoffs, why arbitrary numbers don’t belong in disease treatment, and how clinicians across different specialties can speak about weight with precision and compassion. Dr. Nadler is building training modules for advanced practice providers to close education gaps and equip more teams to act.

This episode is for you if you’ve ever wondered how medicine changes when data meets conviction. 

To connect with Dr. Evan Nadler, please visit: 

YouTube: @ obesityexplained

LinkedIn: Evan Nadler, MD, MBA

Instagram: @obesity_explained

www.obesityexplained.com 

evan.nadler@EPNMD.com

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Ashley :

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor, and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face, and what drives them in their careers. It's access you want and stories you need. Whether you're a pre-health student or simply curious about the healthcare field, I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations. So make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped. And follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests. Most people don't know that pediatric bariatric surgery exists. But my guests today helped create the field. Dr. Evan Nadler has spent more than two decades challenging how medicine approaches childhood obesity, not as a failure of willpower, but as a disease that deserves treatment, compassion, and science-based care. In this episode, we talk about what it means to push against convention, to stand at the microphone at a national conference and defend a new idea when no one else believes in it. You'll hear how Dr. Nadler went from being called a monster for operating on children to helping shape the national guidelines for pediatric obesity care. We also explore what happens when a surgeon decides to step away from what he loves doing in the OR in order to write a book, build a telemedicine practice for families across the country, and redefine what advocacy looks like for millions of children. And above all else, Dr. Nadler reminds us that innovation in medicine doesn't always start with technology. Sometimes it starts with courage. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. This is Shadow Me Next with Dr. Evan Nadler. Dr. Nadler, thank you so much for joining us today on Shadow Me Next. I am so grateful for your time and expertise and to be able to ask you some of these really interesting questions about childhood obesity today. Thank you so much.

Dr. Nadler:

Oh, my pleasure. Happy to be here.

Ashley :

So let's see, you are the nation's leading pediatric bariatric surgeon, which means you are doing these major, major weight loss surgeries on some of the smallest, uh, the youngest patients, really. Um, and you've been treating children with obesity for 20 years plus. Uh, that's incredible. How how would you describe your role in medicine?

Dr. Nadler:

First, I probably should say that most of the world doesn't even know that pediatric bariatric surgery is a thing, like that that even exists.

Ashley :

Right.

Dr. Nadler:

Um, and it didn't exist until about 2004 when a group of pediatric surgeons decided they would start thinking about or investigating the possibility to do bariatric surgery on kids. And actually, at that time I was a trainee. Um, and but was invited by one of my mentors to participate in this call of these pediatric surgeons. And then got started. We did a couple of those cases while I was a trainee. And then my mentor decided he was never gonna do that ever again because he hated it so much. And I decided that there had to be a better way than what everybody else in the country was thinking at that time. So I sort of went on my own sort of rogue journey um about uh you know, doing actually at that time I was doing something called laparoscopic adjustable gastric banding for kids, which fell out of favor maybe 10 years ago now, if not longer. Um so anyway, but now like after that group was doing their thing and I was doing my thing, we all sort of came together at some point. And um so to answer your your question about my role in medicine, I've always been I've had a basic science lab. I actually had a startup company based on my basic and translational science. And I've just always challenged the existing dogma and challenged authority for better or worse. It's probably kept me from being a chair of surgery or higher up in the administration in hospitals because I don't I just don't do what I'm told all the time. Um if I don't understand it or don't think it's right, or I would I would not be good in the military for that reason. Um but so I would say my role in medicine has really just to been doing surgery that others wouldn't consider doing. And I've always felt that you know, as long as you explain the risks and the benefits to the individual families who are who are making the decision, and as long as you're studying what you're doing and publishing it, so that if it doesn't work out, people are still learning something. Um, that was always sort of how I viewed it. I wasn't gonna do what everybody else did because just because they were doing it, I was gonna do what I thought was right for the patient. And that's sort of what's kept me going for 20 some odd years at this point.

Ashley :

Thank you so much for saying that. And that's exactly where I was trying to go with this question, which actually beautifully leads into the next question. It's one of the reasons I was so interested to talk to you is that over the last decades in practice, you have presented ideas that go against the grain, right? Before we continue our conversation with Dr. Nadler, I'd like to pause for quality questions. This is a segment on the show designed to help introduce pre-health students to the kinds of thoughtful, reflective questions they might face in their own future interviews and to practice answering them fluidly and with intention. So today's quality question is Are you a person who challenges the status quo? Describe a time you went against the grain. What was the outcome? In medicine, this kind of question gets to the heart of innovation and integrity. Whether you're standing up for a patient, questioning an outdated process, or simply offering a new perspective, admissions teams want to see that you can think critically, communicate respectfully, and lead with purpose. Keep in mind that there's more interview prep, such as mock interviews and personal statement review, over on Shadowme Next.com. There you'll find amazing resources to help you as you prepare to answer your own quality questions. My question to you is what is it like to challenge some of these conventions? I mean, I'm sure it's I'm sure it's challenging. So things like, let's list a couple, things like obesity is a disease and not a lifestyle choice. That's one. Health and weight are not inextricably linked. That's two. Why traditional advice like eat less, move more isn't enough? I mean, these are these are things, like I said, that go against the grain. They're very unique ideas. Is it just easy to walk into a place and say, I think you guys are thinking wrong? Um, we need to fix this.

Dr. Nadler:

So one of my favorite stories from the early days, the early, early days, this was probably, I don't even remember how long ago this was, but probably 2000, I don't know, eight, seven, something like that. I was uh so I was actually, so I was doing labaroscopic adjustable gastric banding in teenagers for weight management um as part of an FDA approved trial. Like it wasn't just me going totally, you know, on my own. I was actually doing it as a research study through proper channels. And I was invited to a um professional society's national meeting to discuss my data because it was new and unique and whatever. Um, and it was not, I'll just say it wasn't a surgical society, it was a medical society. I won't name it so that no one has to get any uh hate mail or whatever. But I, you know, I give my talk 20 minute, 10 minute, I don't remember. Um QA comes up, and like the first guy who gets up is like, how do you sleep at night offering surgery to children for weight loss? Like, totally just and I probably am making it more PC than it was, or at least how I remember it. But it he basically was calling if he had, and this is an old reference because I'm an old guy, but if he had tomatoes to throw at me, I'm sure the guy would have thrown tomatoes at me. And uh I don't know if he called me a monster or not, but I felt like he was calling me a monster. And you know, I said to him, I said, listen, I sort of know what will happen to these children if we don't treat them. And if you spend one day in my clinic, just one day in my clinic talking to these kids, it'll change your life. You'll you won't have that opinion any longer. And of course, he was like, you know, he didn't really like that answer or whatever. Um, again, answering your question, it's not easy and it's not for the faint of heart. And however, you know, I had the courage of my conviction. I was totally convinced that I was in the right and that the rest of the medical community was in the wrong. And again, I used to joke that in the early days I used to say, 20 years from now, I'm either going to be a genius or a heretic. And it's 20 years later, and I think the jury is still out, which is unlikely to be. But I think I'm getting closer maybe to just being, oh, geniuses overstating it, but you know, I'm getting, you know, the American Academy of Pediatrics now um recommends surgery for down to the age of 13 uh for children with obesity, in large part from my experience. There's another big group of surgeons, that group I was talking about from 2004. They certainly have a lot to do with it as well because of their NIH-funded studies. But um I've done more cases than anybody else in the country, so I have more sort of clinical experience and published a few years ago the data in patients under 13 because I was so angry at the American Academy of Pediatrics for using a number cutoff because there is no reason to have a number cutoff. It's a disease. There's no other disease that we withhold treatment for based on age. Like it's just makes me getting angry now. I'm getting all heated now. It's too early in the morning to be getting heated when I'm heated already.

Ashley :

Oh, well, it shows your passion, you know, and I'm just I'm so grateful that we have people that stand in medicine that stand on their beliefs and and beliefs that aren't just arbitrary. These are things that you've seen in clinic, these are things that you've experienced, not just maybe successes, but tangible, tangible, lifelong successes, I would imagine. I would love to talk to you about. We've talked about surgery, we've talked about clinic a little bit. What does your day, uh, what's a day in your life look like? I'm sure it's very different when you're in clinic versus surgery, but just for those interested in what is a pediatric bariatric surgeon?

Dr. Nadler:

Yeah, yeah. So actually it's even more complicated than that because I tentatively, I've I put my pediatric bariatric surgery career on hold two years ago to write a book on childhood obesity, to um start a pediatric telemedicine weight management program, which obviously I can't do surgery remotely yet. Maybe some there's the robot, and so it's possible, but that's not that's not part of the plan. Um, because I basically I decided that helping 150 kids a year with surgery was great, and I've done that for 20 years, but there's so much more to do. There are 15 million children in the United States with obesity, and I can't possibly treat even a small fraction of those. So, how do I expand my reach and frankly um help others learn from my 20 years of fighting the system? Um so today I actually do something called locum tenants. So I actually um currently because writing a book and starting a YouTube channel and starting a new practice and being a patient advocate, all those sum together to provide me a paycheck that is zero. So I have to pay the bill somehow. So what I do is I do this local tenants work where I basically go to hospitals, children's hospitals and others, but children's hospitals that don't have enough pediatric surgery coverage, and I like basically work there for a week so that the pediatric surgeons are there full time can uh can get a break. Um, so I actually not doing the bariatric surgery part of that equation right now. Um but I can tell you what I used to do, which is you know, like when you're I was sort of a I was a surgeon scientist, so I sort of had 50% clinical and 50% uh science. And and that's again unique to sort of academic practices. I didn't know anything about academic practice versus private practice. Um, you know, I I when I was in residency, I learned some about that. Um but some of these other options like locum tenants, I had no idea what that was because like for me, I there was always sort of this push towards academia because I went to an academic medical school and I went to an academic surgery training program and an academic pediatric surgery training program. So it was always sort of what I was gonna do. You know, I never really did hear or think about some of the other options until much later.

Ashley :

You're absolutely right. I do think that there are a lot of gaps in education about these different areas that we can practice, and that is why it's just amazing to me to have these conversations with healthcare providers such as yourself, where, you know, we imagine, oh, I'm going to go into general surgery, for example, and that's what I'm going to do for the rest of my life. And then it becomes pediatric surgery, and then it becomes pediatric bariatric surgery, which is super specialized. And then, oh, wait, I see this other need that I can fill. And now, and now you're filling that. So I think, I think the flexibility that you're describing right now, and the ability to create a YouTube channel and write a book and begin this whole telemedicine practice, which I do want to talk about, is just incredible. You know, so I think that that so often people are discouraged from medicine, specifically becoming a medical doctor because they believe it's a it's a one-size, one way, one path for the rest of their life. And you are you're living proof that that is not true. Your your passions can change, your interests can change, and and where you're utilized can change too. So thanks for describing that. That was great.

Dr. Nadler:

Yeah. Well, there's certainly, you know, the this was not the path I mapped when I was in, you know, a fourth-year medical student at age 25 or whatever. This was not where I thought I would be 30 years later by any stretch of the imagination. And uh certainly I didn't go into pediatric surgery thinking to myself, oh, I'm gonna take care of you know, 300-pound 15-year-olds. That's not that was not on my radar. It was on no one's radar when I was uh in training. Um, but yeah, like you know, for me anyway, it's been a sort of you sort of described it. Where's the need? What can I do that others may not be able to do? Um, how can I help the most people, really, is what it comes down to. And and and follow my passion and also not compromise along the way. Just not not let people tell me I can't or you shouldn't or don't, um, you know, for right or for wrong, right? Like it's probably my my career path, I'm sure, has been much harder than it needed to be. If I'd just been able to be a little bit more of a sandbox player with everybody and and and be nice along the way about it. But for me personally, I was always just such a fierce patient advocate, especially for this group of patients, patients with childhood obesity that no one really wanted to take care of or knew how to take care of. So I was always fighting for resources, always fighting for recognition, always fighting for um, well, just fighting for them. And um yeah, so anyway, so that is one piece of the one piece of advice that you sort of alluded to that I do give students that I work with today is just keep an open mind and don't like you know, you never know when opportunity might hit, um, and you never know what that opportunity might be. So just be open to change or to thinking differently, whether it be medical or career-wise or life-wise or whatever. Because I think when we get stuck in our sort of, you know, our our um, well, if we get, you know, our put if our blinders are on and we can't look around us and see what else is out there, sometimes we might miss um great opportunities to do amazing things.

Ashley :

That is so beautifully said. I love that so much. Um well, I was gonna talk about how obesity medicine is evolving rapidly. And and I do still want to talk about that, but but not in the way of new drugs, which of course we're all hearing so much about or new devices, um, but really emerging, emerging therapies, but more emerging options. And this is where I want to talk about your pediatric weight management telemedicine practice, because, like you said, you've always fought for your patients, you've always pursued patient advocacy. And this is one way that you're doing so. It is so hard to talk to pediatric patients and their parents about weight. And we've mentioned this on the podcast before. We had a nutritionist PA come on and she works in pediatrics and she's trained in this. And she said she is constantly having to reverse the conversations that clinicians, PAs, MDs are already having. So tell us why this pediatric weight management telemedicine practice is so crucially important right now.

Dr. Nadler:

There just aren't enough programs out there to treat the 15 million kids who need help. And even in the big urban centers where like I used to work, we had a several hundred patient waiting lists just to get in the door. Um, and that's the same story it at all the tertiary care children's hospitals that have programs, basically. So my um my co-founder, my partner in this used to run the weight management clinic at uh Children's Hospital Atlanta, and I had mine in DC. And we initially got together thinking, well, we're both 20 years plus into this, and we have all this valuable knowledge, and we were at the very beginnings of it all when it first started. So let's form a consulting um company. Well, it was just the two of us, and we would go around and just teach other people how to do it and help them build programs locally. And after a year of pitching and not a single place being interested in doing that, I went back to business school as part of my startup company. So I actually was also pitching, I can show you how to do it profitably. So after a year of doing that, and truly no one we had people get interested, but every time I got to a hospital administrator, we had docs who were interested. Every time I got to a hospital administrator, it stopped. Conversation stopped. So my partner and I said, okay, well, if we can't teach people how to do it, we have to just suck it up and show people how to do it again. Because we already had done it, showed people how to do it in brick and mortar clinics, but now we're going to show people how to do it via telemedicine. Because obviously that increases access because you don't have to, if you're in rural America, you don't have to drive two hours to get to your university health center or whatever, wherever you would go. If you're in a big city, but you're on the wrong side of that city from the one hospital in town that has the clinic, and you have to drive an hour and fight traffic and miss a half day of work or miss school or whatever. We're just trying to take a lot of those barriers out of the way. And again, just increase access to care, which is which is the first step. It's just getting in the door. And then we can talk about what's right for you. Lifestyle changes are right for everybody, but don't always achieve a lot of weight loss. Medications, is that something that your insurance even covers? Is even a possibility. Cause that's a whole nother episode, if not, you know, whole series. Um, and then you know, surgery, which many people still view as a last resort, which I don't think I don't think it should be considered that way, but that's still how lots of people talk about it. So that's what we're trying to do. I'll come back in a year and tell you how it went.

Ashley :

Yes, please do. As we mentioned multiple times on this show, just because I work in dermatology, that does not mean that I don't have questions or conversations about weight management with my patients. Sometimes it's underweight and we're discussing how to gain weight in a healthy way. Sometimes it's overweight, and we're discussing all of the dermatologic conditions and concerns that that are derived because of that. And so for me, to have a resource and a tool like this available is is incredible. And I and I'm I'm so grateful for you for really stepping up and creating this because I know it has been um uh it's been a journey and uh a challenge, and I'm really excited to see where it goes from here. Dr. Nadler, this has been such a great conversation. I'm sure a lot of people are so interested in this telemedicine practice in your YouTube channel, in your book.

Dr. Nadler:

I actually have another project which we didn't even talk about, which is creating pediatric obesity uh training modules for APPs, among other folks. Um, because there are gaps in in the education in med schools, there needs to be more obesity education and pediatric obesity education in residency programs. There needs to be more pediatric obesity education. So I'm trying to tackle all those things all at once, which you know, it's just why ADD is a superpower and not a disease as some other people think about it. As long as you can control it from time to time.

Ashley :

It just opens the door and it's a perfect gateway to having these really hard conversations that we don't have to have alone because we have you and your incredible resources. So, Dr. Evan Nadler, thank you so much for joining us today.

Dr. Nadler:

Hey, my pleasure, Ashley. And I'm um obviously I'm happy to come back and talk anytime about pediatric surgery, pediatric dietric surgery, childhood obesity, out-of-the-box thinking, career deviations, anything, anything, anything you ever want to talk about. I'm always I'm always open to to give my opinion, whether it's asked for or not.

Ashley :

I think that's fantastic, and I'm so grateful. Thank you. Thank you so much. My pleasure. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode, or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday. As always, if you have any questions, let me know on Facebook or Instagram. Access you want, stories you need, you're always invited to Shadow Me Next.

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Ashley Love

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