John Simon III was a hungry baby and a “chunky” toddler who grew into a chubby little boy, his mother said. But by the time the California middle-schooler turned 14, his weight had soared to 430 pounds and become a life-threatening medical condition.Now, nine months after weight-loss surgery that removed a portion of his stomach, John has lost more than 150 pounds, boosting his health and his hopes for the future.“It was like a whole new start,” said John.John is among a small but growing group of young teens using drastic treatments – body-altering surgery, new drugs that rewire metabolism to lose large amounts of weight. The kids and their parents say the aggressive measures are a necessary option after years of failed diets and exercise programs.The aggressive interventions are backed by experts who treat obesity in children, who say that safe and effective tools are crucial when 80% of adolescents with excess weight carry it into adulthood with dire consequences for their health and longevity.Social media exploded with comments accusing doctors and parents of taking the easy way out – or worse.“How about this? Less junk food, less XBox and more outside time,” a typical Twitter comment said. “This is child abuse,” read another.But medical experts who treat kids with severe obesity disagree. More than 240 diseases are associated with excess weight and signs of metabolic disease including liver problems, diabetes, inflammation and they show up early, said Dr. Janey Pratt, the Stanford University surgeon who performed gastric sleeve surgery on John Simon in September 2022.“"The magical thing about surgery is that it takes that hunger away. And the children change," said Pratt. "They become new people."Starting in grade school, as his weight increased, John struggled with joint pain, shortness of breath and sleep apnea so severe that, at age 12, he needed coffee in the mornings to stay awake. He developed anxiety triggered by daily bullying from kids at school. When he was in sixth grade, he was hospitalized for two months with post-traumatic stress disorder caused by the nearly constant abuse.John tried diets and exercise, sometimes losing as much as 40 pounds. But he endured intense food cravings that meant the weight always came back plus more.John was referred to the Stanford Medicine Children’s Health weight-loss program run by Pratt and her former partner, surgeon Dr. Matias Bruzoni. It meant traveling to Palo Alto, 350 miles north, but his mother, Karen Tillman, was ready to do anything.The Stanford program is among the busiest sites in the U.S., performing more than 50 of the 2,000 pediatric weight-loss surgeries logged each year. John was fortunate. Only about 2% of children who qualify for the procedure receive metabolic surgery.Just a fraction of those have the estimated cost of the procedure and care which can top $100,000 covered by private insurance or Medicaid. In California, where John lives, Medi-Cal program covered 47 operations for kids ages 11 to 17, records show.Since the release of the AAP guidelines, sign-ups for the Stanford surgery program have doubled, Pratt said. Requests for obesity drugs have soared.Not everyone who inquires enrolls in the program, and not everyone who signs up loses expected amounts of weight or keeps it off. About 1 in 4 kids who undergo weight-loss surgery regain the pounds and need further treatment, including additional surgery, Pratt said. Those who take obesity drugs regain weight once they stop, research shows. Others see side effects that can be serious, including gallstones and inflammation of the pancreas.At the same time, neither surgery nor drugs will necessarily help kids get down to what’s commonly called a “healthy” weight, a BMI of 25 or lower. A key goal of the push to treat kids sooner is to have a better chance of helping them lose enough weight to reduce or halt obesity-related diseases.In the meantime, John, who turned 15 in May, is focused on the future. He has learned to cook healthy meals like a recent dinner of sauteed shrimp and chard thanks to his great-uncle, former Olympic boxer Henry Tillman. He works out at a local gym, puts 18,000 steps on his pedometer every day and hopes to study hard in high school and college to land his dream job -- as an automotive engineer.