October 27, 2025 • 24 mins
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
Virtual shadowing is an important tool to use when planning your medical career. At Shadow Me Next! we want to provide you with the resources you need to find your role in healthcare and secure your place in medicine.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ashley (00:00):
Hello and welcome to Shadow Me Next, a podcast where
I take you into and behind thescenes of the medical world to
provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor, and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face, andwhat drives them in their
careers.
It's access you want andstories you need.
Whether you're a pre-healthstudent or simply curious about
the healthcare field, I inviteyou to join me as we take a
conversational and personal lookinto the lives and minds of
(00:43):
leaders in medicine.
I don't want you to miss asingle one of these
conversations.
So make sure that you subscribeto this podcast, which will
automatically notify you whennew episodes are dropped.
And follow us on Instagram andFacebook at Shadow Me Next,
where we will review highlightsfrom this conversation and where
I'll give you sneak previews ofour upcoming guests.
(01:03):
Most people don't know thatpediatric bariatric surgery
exists.
But my guests today helpedcreate the field.
Dr.
Evan Nadler has spent more thantwo decades challenging how
medicine approaches childhoodobesity, not as a failure of
willpower, but as a disease thatdeserves treatment, compassion,
(01:24):
and science-based care.
In this episode, we talk aboutwhat it means to push against
convention, to stand at themicrophone at a national
conference and defend a new ideawhen no one else believes in
it.
You'll hear how Dr.
Nadler went from being called amonster for operating on
children to helping shape thenational guidelines for
(01:45):
pediatric obesity care.
We also explore what happenswhen a surgeon decides to step
away from what he loves doing inthe OR in order to write a
book, build a telemedicinepractice for families across the
country, and redefine whatadvocacy looks like for millions
of children.
And above all else, Dr.
Nadler reminds us thatinnovation in medicine doesn't
(02:08):
always start with technology.
Sometimes it starts withcourage.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
(02:29):
official policy or position ofany other agency, organization,
employer, or company.
This is Shadow Me Next with Dr.
Evan Nadler.
Dr.
Nadler, thank you so much forjoining us today on Shadow Me
Next.
I am so grateful for your timeand expertise and to be able to
ask you some of these reallyinteresting questions about
childhood obesity today.
(02:50):
Thank you so much.
Dr. Nadler (02:51):
Oh, my pleasure.
Happy to be here.
Ashley (02:53):
So let's see, you are the nation's leading pediatric
bariatric surgeon, which meansyou are doing these major, major
weight loss surgeries on someof the smallest, uh, the
youngest patients, really.
Um, and you've been treatingchildren with obesity for 20
years plus.
Uh, that's incredible.
How how would you describe yourrole in medicine?
Dr. Nadler (03:15):
First, I probably should say that most of the
world doesn't even know thatpediatric bariatric surgery is a
thing, like that that evenexists.
Ashley (03:22):
Right.
Dr. Nadler (03:23):
Um, and it didn't exist until about 2004 when a
group of pediatric surgeonsdecided they would start
thinking about or investigatingthe possibility to do bariatric
surgery on kids.
And actually, at that time Iwas a trainee.
Um, and but was invited by oneof my mentors to participate in
(03:47):
this call of these pediatricsurgeons.
And then got started.
We did a couple of those caseswhile I was a trainee.
And then my mentor decided hewas never gonna do that ever
again because he hated it somuch.
And I decided that there had tobe a better way than what
everybody else in the countrywas thinking at that time.
(04:07):
So I sort of went on my ownsort of rogue journey um about
uh you know, doing actually atthat time I was doing something
called laparoscopic adjustablegastric banding for kids, which
fell out of favor maybe 10 yearsago now, if not longer.
Um so anyway, but now likeafter that group was doing their
(04:30):
thing and I was doing my thing,we all sort of came together at
some point.
And um so to answer your yourquestion about my role in
medicine, I've always been I'vehad a basic science lab.
I actually had a startupcompany based on my basic and
translational science.
And I've just always challengedthe existing dogma and
(04:54):
challenged authority for betteror worse.
It's probably kept me frombeing a chair of surgery or
higher up in the administrationin hospitals because I don't I
just don't do what I'm told allthe time.
Um if I don't understand it ordon't think it's right, or I
would I would not be good in themilitary for that reason.
(05:16):
Um but so I would say my rolein medicine has really just to
been doing surgery that otherswouldn't consider doing.
And I've always felt that youknow, as long as you explain the
risks and the benefits to theindividual families who are who
(05:36):
are making the decision, and aslong as you're studying what
you're doing and publishing it,so that if it doesn't work out,
people are still learningsomething.
Um, that was always sort of howI viewed it.
I wasn't gonna do whateverybody else did because just
because they were doing it, Iwas gonna do what I thought was
right for the patient.
And that's sort of what's keptme going for 20 some odd years
(06:03):
at this point.
Ashley (06:04):
Thank you so much for saying that.
And that's exactly where I wastrying to go with this question,
which actually beautifullyleads into the next question.
It's one of the reasons I wasso interested to talk to you is
that over the last decades inpractice, you have presented
ideas that go against the grain,right?
Before we continue ourconversation with Dr.
Nadler, I'd like to pause forquality questions.
(06:25):
This is a segment on the showdesigned to help introduce
pre-health students to the kindsof thoughtful, reflective
questions they might face intheir own future interviews and
to practice answering themfluidly and with intention.
So today's quality question isAre you a person who challenges
the status quo?
Describe a time you wentagainst the grain.
(06:47):
What was the outcome?
In medicine, this kind ofquestion gets to the heart of
innovation and integrity.
Whether you're standing up fora patient, questioning an
outdated process, or simplyoffering a new perspective,
admissions teams want to seethat you can think critically,
communicate respectfully, andlead with purpose.
(07:07):
Keep in mind that there's moreinterview prep, such as mock
interviews and personalstatement review, over on
Shadowme Next.com.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
My question to you is what isit like to challenge some of
these conventions?
I mean, I'm sure it's I'm sureit's challenging.
So things like, let's list acouple, things like obesity is a
(07:31):
disease and not a lifestylechoice.
That's one.
Health and weight are notinextricably linked.
That's two.
Why traditional advice like eatless, move more isn't enough?
I mean, these are these arethings, like I said, that go
against the grain.
They're very unique ideas.
Is it just easy to walk into aplace and say, I think you guys
are thinking wrong?
Um, we need to fix this.
Dr. Nadler (07:51):
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 likethat.
I was uh so I was actually, soI was doing labaroscopic
adjustable gastric banding inteenagers for weight management
(08:12):
um as part of an FDA approvedtrial.
Like it wasn't just me goingtotally, you know, on my own.
I was actually doing it as aresearch study through proper
channels.
And I was invited to a umprofessional society's national
meeting to discuss my databecause it was new and unique
(08:35):
and whatever.
Um, and it was not, I'll justsay it wasn't a surgical
society, it was a medicalsociety.
I won't name it so that no onehas to get any uh hate mail or
whatever.
But I, you know, I give my talk20 minute, 10 minute, I don't
remember.
Um QA comes up, and like thefirst guy who gets up is like,
(08:58):
how do you sleep at nightoffering surgery to children for
weight loss?
Like, totally just and Iprobably am making it more PC
than it was, or at least how Iremember it.
But it he basically was callingif he had, and this is an old
(09:19):
reference because I'm an oldguy, but if he had tomatoes to
throw at me, I'm sure the guywould have thrown tomatoes at
me.
And uh I don't know if hecalled me a monster or not, but
I felt like he was calling me amonster.
And you know, I said to him, Isaid, listen, I sort of know
what will happen to thesechildren if we don't treat them.
(09:39):
And if you spend one day in myclinic, just one day in my
clinic talking to these kids,it'll change your life.
You'll you won't have thatopinion any longer.
And of course, he was like, youknow, he didn't really like
that answer or whatever.
Um, again, answering yourquestion, it's not easy and it's
not for the faint of heart.
And however, you know, I hadthe courage of my conviction.
(10:04):
I was totally convinced that Iwas in the right and that the
rest of the medical communitywas in the wrong.
And again, I used to joke thatin the early days I used to say,
20 years from now, I'm eithergoing to be a genius or a
heretic.
And it's 20 years later, and Ithink the jury is still out,
which is unlikely to be.
(10:24):
But I think I'm getting closermaybe to just being, oh,
geniuses overstating it, but youknow, I'm getting, you know,
the American Academy ofPediatrics now um recommends
surgery for down to the age of13 uh for children with obesity,
in large part from myexperience.
There's another big group ofsurgeons, that group I was
(10:46):
talking about from 2004.
They certainly have a lot to dowith it as well because of
their NIH-funded studies.
But um I've done more casesthan anybody else in the
country, so I have more sort ofclinical experience and
published a few years ago thedata in patients under 13
because I was so angry at theAmerican Academy of Pediatrics
(11:10):
for using a number cutoffbecause there is no reason to
have a number cutoff.
It's a disease.
There's no other disease thatwe withhold treatment for based
on age.
Like it's just makes me gettingangry now.
I'm getting all heated now.
It's too early in the morningto be getting heated when I'm
heated already.
Ashley (11:27):
Oh, well, it shows your passion, you know, and I'm just
I'm so grateful that we havepeople that stand in medicine
that stand on their beliefs andand beliefs that aren't just
arbitrary.
These are things that you'veseen in clinic, these are things
that you've experienced, notjust maybe successes, but
tangible, tangible, lifelongsuccesses, I would imagine.
I would love to talk to youabout.
We've talked about surgery,we've talked about clinic a
little bit.
(11:48):
What does your day, uh, what'sa day in your life look like?
I'm sure it's very differentwhen you're in clinic versus
surgery, but just for thoseinterested in what is a
pediatric bariatric surgeon?
Dr. Nadler (11:57):
Yeah, yeah.
So actually it's even morecomplicated than that because I
tentatively, I've I put mypediatric bariatric surgery
career on hold two years ago towrite a book on childhood
obesity, to um start a pediatrictelemedicine weight management
(12:17):
program, which obviously I can'tdo surgery remotely yet.
Maybe some there's the robot,and so it's possible, but that's
not that's not part of theplan.
Um, because I basically Idecided that helping 150 kids a
year with surgery was great, andI've done that for 20 years,
but there's so much more to do.
(12:38):
There are 15 million childrenin the United States with
obesity, and I can't possiblytreat even a small fraction of
those.
So, how do I expand my reachand frankly um help others learn
from my 20 years of fightingthe system?
Um so today I actually dosomething called locum tenants.
(13:03):
So I actually um currentlybecause writing a book and
starting a YouTube channel andstarting a new practice and
being a patient advocate, allthose sum together to provide me
a paycheck that is zero.
So I have to pay the billsomehow.
So what I do is I do this localtenants work where I basically
(13:25):
go to hospitals, children'shospitals and others, but
children's hospitals that don'thave enough pediatric surgery
coverage, and I like basicallywork there for a week so that
the pediatric surgeons are therefull time can uh can get a
break.
Um, so I actually not doing thebariatric surgery part of that
(13:49):
equation right now.
Um but I can tell you what Iused to do, which is you know,
like when you're I was sort of aI was a surgeon scientist, so I
sort of had 50% clinical and50% uh science.
And and that's again unique tosort of academic practices.
I didn't know anything aboutacademic practice versus private
(14:11):
practice.
Um, you know, I I when I was inresidency, I learned some about
that.
Um but some of these otheroptions like locum tenants, I
had no idea what that wasbecause like for me, I there was
always sort of this pushtowards academia because I went
to an academic medical schooland I went to an academic
(14:33):
surgery training program and anacademic pediatric surgery
training program.
So it was always sort of what Iwas gonna do.
You know, I never really didhear or think about some of the
other options until much later.
Ashley (14:44):
You're absolutely right.
I do think that there are a lotof gaps in education about
these different areas that wecan practice, and that is why
it's just amazing to me to havethese conversations with
healthcare providers such asyourself, where, you know, we
imagine, oh, I'm going to gointo general surgery, for
example, and that's what I'mgoing to do for the rest of my
life.
And then it becomes pediatricsurgery, and then it becomes
pediatric bariatric surgery,which is super specialized.
(15:07):
And then, oh, wait, I see thisother need that I can fill.
And now, and now you're fillingthat.
So I think, I think theflexibility that you're
describing right now, and theability to create a YouTube
channel and write a book andbegin this whole telemedicine
practice, which I do want totalk about, is just incredible.
You know, so I think that thatso often people are discouraged
(15:29):
from medicine, specificallybecoming a medical doctor
because they believe it's a it'sa one-size, one way, one path
for the rest of their life.
And you are you're living proofthat that is not true.
Your your passions can change,your interests can change, and
and where you're utilized canchange too.
So thanks for describing that.
That was great.
Dr. Nadler (15:45):
Yeah.
Well, there's certainly, youknow, the this was not the path
I mapped when I was in, youknow, a fourth-year medical
student at age 25 or whatever.
This was not where I thought Iwould be 30 years later by any
stretch of the imagination.
And uh certainly I didn't gointo pediatric surgery thinking
(16:06):
to myself, oh, I'm gonna takecare of you know, 300-pound
15-year-olds.
That's not that was not on myradar.
It was on no one's radar when Iwas 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 maynot be able to do?
Um, how can I help the mostpeople, really, is what it comes
(16:29):
down to.
And and and follow my passionand also not compromise along
the way.
Just not not let people tell meI can't or you shouldn't or
don't, um, you know, for rightor for wrong, right?
Like it's probably my my careerpath, I'm sure, has been much
harder than it needed to be.
If I'd just been able to be alittle bit more of a sandbox
(16:52):
player with everybody and andand be nice along the way about
it.
But for me personally, I wasalways just such a fierce
patient advocate, especially forthis group of patients,
patients with childhood obesitythat no one really wanted to
take care of or knew how to takecare of.
So I was always fighting forresources, always fighting for
recognition, always fighting forum, well, just fighting for
(17:16):
them.
And um yeah, so anyway, so thatis one piece of the one piece
of advice that you sort ofalluded to that I do give
students that I work with todayis just keep an open mind and
don't like you know, you neverknow when opportunity might hit,
um, and you never know whatthat opportunity might be.
So just be open to change or tothinking differently, whether
(17:43):
it be medical or career-wise orlife-wise or whatever.
Because I think when we getstuck in our sort of, you know,
our our um, well, if we get, youknow, our put if our blinders
are on and we can't look aroundus and see what else is out
there, sometimes we might missum great opportunities to do
amazing things.
Ashley (18:04):
That is so beautifully said.
I love that so much.
Um well, I was gonna talk abouthow obesity medicine is
evolving rapidly.
And and I do still want to talkabout that, but but not in the
way of new drugs, which ofcourse we're all hearing so much
about or new devices, um, butreally emerging, emerging
therapies, but more emergingoptions.
(18:24):
And this is where I want totalk about your pediatric weight
management telemedicinepractice, because, like you
said, you've always fought foryour patients, you've always
pursued patient advocacy.
And this is one way that you'redoing so.
It is so hard to talk topediatric patients and their
parents about weight.
And we've mentioned this on thepodcast before.
(18:45):
We had a nutritionist PA comeon and she works in pediatrics
and she's trained in this.
And she said she is constantlyhaving to reverse the
conversations that clinicians,PAs, MDs are already having.
So tell us why this pediatricweight management telemedicine
practice is so cruciallyimportant right now.
Dr. Nadler (19:03):
There just aren't enough programs out there to
treat the 15 million kids whoneed help.
And even in the big urbancenters where like I used to
work, we had a several hundredpatient waiting lists just to
get in the door.
Um, and that's the same storyit at all the tertiary care
(19:26):
children's hospitals that haveprograms, basically.
So my um my co-founder, mypartner in this used to run the
weight management clinic at uhChildren's Hospital Atlanta, and
I had mine in DC.
And we initially got togetherthinking, well, we're both 20
(19:47):
years plus into this, and wehave all this valuable
knowledge, and we were at thevery beginnings of it all when
it first started.
So let's form a consulting umcompany.
Well, it was just the two ofus, and we would go around and
just teach other people how todo it and help them build
programs locally.
And after a year of pitchingand not a single place being
(20:13):
interested in doing that, I wentback to business school as part
of my startup company.
So I actually was alsopitching, 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 Igot to a hospital
administrator, we had docs whowere interested.
Every time I got to a hospitaladministrator, it stopped.
(20:34):
Conversation stopped.
So my partner and I said, okay,well, if we can't teach people
how to do it, we have to justsuck 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, butnow we're going to show people
how to do it via telemedicine.
(20:56):
Because obviously thatincreases access because you
don't have to, if you're inrural America, you don't have to
drive two hours to get to youruniversity health center or
whatever, wherever you would go.
If you're in a big city, butyou're on the wrong side of that
city from the one hospital intown that has the clinic, and
you have to drive an hour andfight traffic and miss a half
(21:17):
day of work or miss school orwhatever.
We're just trying to take a lotof those barriers out of the
way.
And again, just increase accessto care, which is which is the
first step.
It's just getting in the door.
And then we can talk aboutwhat's right for you.
Lifestyle changes are right foreverybody, but don't always
achieve a lot of weight loss.
(21:37):
Medications, is that somethingthat your insurance even covers?
Is even a possibility.
Cause that's a whole notherepisode, if not, you know, whole
series.
Um, and then you know, surgery,which many people still view as
a last resort, which I don'tthink I don't think it should be
(22:00):
considered that way, but that'sstill how lots of people talk
about it.
So that's what we're trying todo.
I'll come back in a year andtell you how it went.
Ashley (22:08):
Yes, please do.
As we mentioned multiple timeson this show, just because I
work in dermatology, that doesnot mean that I don't have
questions or conversations aboutweight management with my
patients.
Sometimes it's underweight andwe're discussing how to gain
weight in a healthy way.
Sometimes it's overweight, andwe're discussing all of the
dermatologic conditions andconcerns that that are derived
(22:29):
because of that.
And so for me, to have aresource and a tool like this
available is is incredible.
And I and I'm I'm so gratefulfor you for really stepping up
and creating this because I knowit has been um uh it's been a
journey and uh a challenge, andI'm really excited to see where
it goes from here.
Dr.
Nadler, this has been such agreat conversation.
(22:50):
I'm sure a lot of people are sointerested in this telemedicine
practice in your YouTubechannel, in your book.
Dr. Nadler (22:56):
I actually have another project which we didn't
even talk about, which iscreating pediatric obesity uh
training modules for APPs, amongother folks.
Um, because there are gaps inin the education in med schools,
there needs to be more obesityeducation and pediatric obesity
education in residency programs.
There needs to be morepediatric obesity education.
(23:17):
So I'm trying to tackle allthose things all at once, which
you know, it's just why ADD is asuperpower and not a disease as
some other people think aboutit.
As long as you can control itfrom time to time.
Ashley (23:33):
It just opens the door and it's a perfect gateway to
having these really hardconversations that we don't have
to have alone because we haveyou and your incredible
resources.
So, Dr.
Evan Nadler, thank you so muchfor joining us today.
Dr. Nadler (23:46):
Hey, my pleasure, Ashley.
And I'm um obviously I'm happyto 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 toto give my opinion, whether it's
asked for or not.
Ashley (24:07):
I think that's fantastic, and I'm so grateful.
Thank you.
Thank you so much.
My pleasure.
Thank you so very much forlistening to this episode of
Shadow Me Next.
If you liked this episode, orif you think it could be useful
for a friend, please subscribeand invite them to join us next
Monday.
As always, if you have anyquestions, let me know on
Facebook or Instagram.
(24:27):
Access you want, stories youneed, you're always invited to
Shadow Me Next.
Hello and welcome to Shadow Me Next, a podcast where
I take you into and behind thescenes of the medical world to
provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor, and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face, andwhat drives them in their
careers.
It's access you want andstories you need.
Whether you're a pre-healthstudent or simply curious about
the healthcare field, I inviteyou to join me as we take a
conversational and personal lookinto the lives and minds of
(00:43):
leaders in medicine.
I don't want you to miss asingle one of these
conversations.
So make sure that you subscribeto this podcast, which will
automatically notify you whennew episodes are dropped.
And follow us on Instagram andFacebook at Shadow Me Next,
where we will review highlightsfrom this conversation and where
I'll give you sneak previews ofour upcoming guests.
(01:03):
Most people don't know thatpediatric bariatric surgery
exists.
But my guests today helpedcreate the field.
Dr.
Evan Nadler has spent more thantwo decades challenging how
medicine approaches childhoodobesity, not as a failure of
willpower, but as a disease thatdeserves treatment, compassion,
(01:24):
and science-based care.
In this episode, we talk aboutwhat it means to push against
convention, to stand at themicrophone at a national
conference and defend a new ideawhen no one else believes in
it.
You'll hear how Dr.
Nadler went from being called amonster for operating on
children to helping shape thenational guidelines for
(01:45):
pediatric obesity care.
We also explore what happenswhen a surgeon decides to step
away from what he loves doing inthe OR in order to write a
book, build a telemedicinepractice for families across the
country, and redefine whatadvocacy looks like for millions
of children.
And above all else, Dr.
Nadler reminds us thatinnovation in medicine doesn't
(02:08):
always start with technology.
Sometimes it starts withcourage.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
(02:29):
official policy or position ofany other agency, organization,
employer, or company.
This is Shadow Me Next with Dr.
Evan Nadler.
Dr.
Nadler, thank you so much forjoining us today on Shadow Me
Next.
I am so grateful for your timeand expertise and to be able to
ask you some of these reallyinteresting questions about
childhood obesity today.
(02:50):
Thank you so much.
Dr. Nadler (02:51):
Oh, my pleasure.
Happy to be here.
Ashley (02:53):
So let's see, you are the nation's leading pediatric
bariatric surgeon, which meansyou are doing these major, major
weight loss surgeries on someof the smallest, uh, the
youngest patients, really.
Um, and you've been treatingchildren with obesity for 20
years plus.
Uh, that's incredible.
How how would you describe yourrole in medicine?
Dr. Nadler (03:15):
First, I probably should say that most of the
world doesn't even know thatpediatric bariatric surgery is a
thing, like that that evenexists.
Ashley (03:22):
Right.
Dr. Nadler (03:23):
Um, and it didn't exist until about 2004 when a
group of pediatric surgeonsdecided they would start
thinking about or investigatingthe possibility to do bariatric
surgery on kids.
And actually, at that time Iwas a trainee.
Um, and but was invited by oneof my mentors to participate in
(03:47):
this call of these pediatricsurgeons.
And then got started.
We did a couple of those caseswhile I was a trainee.
And then my mentor decided hewas never gonna do that ever
again because he hated it somuch.
And I decided that there had tobe a better way than what
everybody else in the countrywas thinking at that time.
(04:07):
So I sort of went on my ownsort of rogue journey um about
uh you know, doing actually atthat time I was doing something
called laparoscopic adjustablegastric banding for kids, which
fell out of favor maybe 10 yearsago now, if not longer.
Um so anyway, but now likeafter that group was doing their
(04:30):
thing and I was doing my thing,we all sort of came together at
some point.
And um so to answer your yourquestion about my role in
medicine, I've always been I'vehad a basic science lab.
I actually had a startupcompany based on my basic and
translational science.
And I've just always challengedthe existing dogma and
(04:54):
challenged authority for betteror worse.
It's probably kept me frombeing a chair of surgery or
higher up in the administrationin hospitals because I don't I
just don't do what I'm told allthe time.
Um if I don't understand it ordon't think it's right, or I
would I would not be good in themilitary for that reason.
(05:16):
Um but so I would say my rolein medicine has really just to
been doing surgery that otherswouldn't consider doing.
And I've always felt that youknow, as long as you explain the
risks and the benefits to theindividual families who are who
(05:36):
are making the decision, and aslong as you're studying what
you're doing and publishing it,so that if it doesn't work out,
people are still learningsomething.
Um, that was always sort of howI viewed it.
I wasn't gonna do whateverybody else did because just
because they were doing it, Iwas gonna do what I thought was
right for the patient.
And that's sort of what's keptme going for 20 some odd years
(06:03):
at this point.
Ashley (06:04):
Thank you so much for saying that.
And that's exactly where I wastrying to go with this question,
which actually beautifullyleads into the next question.
It's one of the reasons I wasso interested to talk to you is
that over the last decades inpractice, you have presented
ideas that go against the grain,right?
Before we continue ourconversation with Dr.
Nadler, I'd like to pause forquality questions.
(06:25):
This is a segment on the showdesigned to help introduce
pre-health students to the kindsof thoughtful, reflective
questions they might face intheir own future interviews and
to practice answering themfluidly and with intention.
So today's quality question isAre you a person who challenges
the status quo?
Describe a time you wentagainst the grain.
(06:47):
What was the outcome?
In medicine, this kind ofquestion gets to the heart of
innovation and integrity.
Whether you're standing up fora patient, questioning an
outdated process, or simplyoffering a new perspective,
admissions teams want to seethat you can think critically,
communicate respectfully, andlead with purpose.
(07:07):
Keep in mind that there's moreinterview prep, such as mock
interviews and personalstatement review, over on
Shadowme Next.com.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
My question to you is what isit like to challenge some of
these conventions?
I mean, I'm sure it's I'm sureit's challenging.
So things like, let's list acouple, things like obesity is a
(07:31):
disease and not a lifestylechoice.
That's one.
Health and weight are notinextricably linked.
That's two.
Why traditional advice like eatless, move more isn't enough?
I mean, these are these arethings, like I said, that go
against the grain.
They're very unique ideas.
Is it just easy to walk into aplace and say, I think you guys
are thinking wrong?
Um, we need to fix this.
Dr. Nadler (07:51):
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 likethat.
I was uh so I was actually, soI was doing labaroscopic
adjustable gastric banding inteenagers for weight management
(08:12):
um as part of an FDA approvedtrial.
Like it wasn't just me goingtotally, you know, on my own.
I was actually doing it as aresearch study through proper
channels.
And I was invited to a umprofessional society's national
meeting to discuss my databecause it was new and unique
(08:35):
and whatever.
Um, and it was not, I'll justsay it wasn't a surgical
society, it was a medicalsociety.
I won't name it so that no onehas to get any uh hate mail or
whatever.
But I, you know, I give my talk20 minute, 10 minute, I don't
remember.
Um QA comes up, and like thefirst guy who gets up is like,
(08:58):
how do you sleep at nightoffering surgery to children for
weight loss?
Like, totally just and Iprobably am making it more PC
than it was, or at least how Iremember it.
But it he basically was callingif he had, and this is an old
(09:19):
reference because I'm an oldguy, but if he had tomatoes to
throw at me, I'm sure the guywould have thrown tomatoes at
me.
And uh I don't know if hecalled me a monster or not, but
I felt like he was calling me amonster.
And you know, I said to him, Isaid, listen, I sort of know
what will happen to thesechildren if we don't treat them.
(09:39):
And if you spend one day in myclinic, just one day in my
clinic talking to these kids,it'll change your life.
You'll you won't have thatopinion any longer.
And of course, he was like, youknow, he didn't really like
that answer or whatever.
Um, again, answering yourquestion, it's not easy and it's
not for the faint of heart.
And however, you know, I hadthe courage of my conviction.
(10:04):
I was totally convinced that Iwas in the right and that the
rest of the medical communitywas in the wrong.
And again, I used to joke thatin the early days I used to say,
20 years from now, I'm eithergoing to be a genius or a
heretic.
And it's 20 years later, and Ithink the jury is still out,
which is unlikely to be.
(10:24):
But I think I'm getting closermaybe to just being, oh,
geniuses overstating it, but youknow, I'm getting, you know,
the American Academy ofPediatrics now um recommends
surgery for down to the age of13 uh for children with obesity,
in large part from myexperience.
There's another big group ofsurgeons, that group I was
(10:46):
talking about from 2004.
They certainly have a lot to dowith it as well because of
their NIH-funded studies.
But um I've done more casesthan anybody else in the
country, so I have more sort ofclinical experience and
published a few years ago thedata in patients under 13
because I was so angry at theAmerican Academy of Pediatrics
(11:10):
for using a number cutoffbecause there is no reason to
have a number cutoff.
It's a disease.
There's no other disease thatwe withhold treatment for based
on age.
Like it's just makes me gettingangry now.
I'm getting all heated now.
It's too early in the morningto be getting heated when I'm
heated already.
Ashley (11:27):
Oh, well, it shows your passion, you know, and I'm just
I'm so grateful that we havepeople that stand in medicine
that stand on their beliefs andand beliefs that aren't just
arbitrary.
These are things that you'veseen in clinic, these are things
that you've experienced, notjust maybe successes, but
tangible, tangible, lifelongsuccesses, I would imagine.
I would love to talk to youabout.
We've talked about surgery,we've talked about clinic a
little bit.
(11:48):
What does your day, uh, what'sa day in your life look like?
I'm sure it's very differentwhen you're in clinic versus
surgery, but just for thoseinterested in what is a
pediatric bariatric surgeon?
Dr. Nadler (11:57):
Yeah, yeah.
So actually it's even morecomplicated than that because I
tentatively, I've I put mypediatric bariatric surgery
career on hold two years ago towrite a book on childhood
obesity, to um start a pediatrictelemedicine weight management
(12:17):
program, which obviously I can'tdo surgery remotely yet.
Maybe some there's the robot,and so it's possible, but that's
not that's not part of theplan.
Um, because I basically Idecided that helping 150 kids a
year with surgery was great, andI've done that for 20 years,
but there's so much more to do.
(12:38):
There are 15 million childrenin the United States with
obesity, and I can't possiblytreat even a small fraction of
those.
So, how do I expand my reachand frankly um help others learn
from my 20 years of fightingthe system?
Um so today I actually dosomething called locum tenants.
(13:03):
So I actually um currentlybecause writing a book and
starting a YouTube channel andstarting a new practice and
being a patient advocate, allthose sum together to provide me
a paycheck that is zero.
So I have to pay the billsomehow.
So what I do is I do this localtenants work where I basically
(13:25):
go to hospitals, children'shospitals and others, but
children's hospitals that don'thave enough pediatric surgery
coverage, and I like basicallywork there for a week so that
the pediatric surgeons are therefull time can uh can get a
break.
Um, so I actually not doing thebariatric surgery part of that
(13:49):
equation right now.
Um but I can tell you what Iused to do, which is you know,
like when you're I was sort of aI was a surgeon scientist, so I
sort of had 50% clinical and50% uh science.
And and that's again unique tosort of academic practices.
I didn't know anything aboutacademic practice versus private
(14:11):
practice.
Um, you know, I I when I was inresidency, I learned some about
that.
Um but some of these otheroptions like locum tenants, I
had no idea what that wasbecause like for me, I there was
always sort of this pushtowards academia because I went
to an academic medical schooland I went to an academic
(14:33):
surgery training program and anacademic pediatric surgery
training program.
So it was always sort of what Iwas gonna do.
You know, I never really didhear or think about some of the
other options until much later.
Ashley (14:44):
You're absolutely right.
I do think that there are a lotof gaps in education about
these different areas that wecan practice, and that is why
it's just amazing to me to havethese conversations with
healthcare providers such asyourself, where, you know, we
imagine, oh, I'm going to gointo general surgery, for
example, and that's what I'mgoing to do for the rest of my
life.
And then it becomes pediatricsurgery, and then it becomes
pediatric bariatric surgery,which is super specialized.
(15:07):
And then, oh, wait, I see thisother need that I can fill.
And now, and now you're fillingthat.
So I think, I think theflexibility that you're
describing right now, and theability to create a YouTube
channel and write a book andbegin this whole telemedicine
practice, which I do want totalk about, is just incredible.
You know, so I think that thatso often people are discouraged
(15:29):
from medicine, specificallybecoming a medical doctor
because they believe it's a it'sa one-size, one way, one path
for the rest of their life.
And you are you're living proofthat that is not true.
Your your passions can change,your interests can change, and
and where you're utilized canchange too.
So thanks for describing that.
That was great.
Dr. Nadler (15:45):
Yeah.
Well, there's certainly, youknow, the this was not the path
I mapped when I was in, youknow, a fourth-year medical
student at age 25 or whatever.
This was not where I thought Iwould be 30 years later by any
stretch of the imagination.
And uh certainly I didn't gointo pediatric surgery thinking
(16:06):
to myself, oh, I'm gonna takecare of you know, 300-pound
15-year-olds.
That's not that was not on myradar.
It was on no one's radar when Iwas 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 maynot be able to do?
Um, how can I help the mostpeople, really, is what it comes
(16:29):
down to.
And and and follow my passionand also not compromise along
the way.
Just not not let people tell meI can't or you shouldn't or
don't, um, you know, for rightor for wrong, right?
Like it's probably my my careerpath, I'm sure, has been much
harder than it needed to be.
If I'd just been able to be alittle bit more of a sandbox
(16:52):
player with everybody and andand be nice along the way about
it.
But for me personally, I wasalways just such a fierce
patient advocate, especially forthis group of patients,
patients with childhood obesitythat no one really wanted to
take care of or knew how to takecare of.
So I was always fighting forresources, always fighting for
recognition, always fighting forum, well, just fighting for
(17:16):
them.
And um yeah, so anyway, so thatis one piece of the one piece
of advice that you sort ofalluded to that I do give
students that I work with todayis just keep an open mind and
don't like you know, you neverknow when opportunity might hit,
um, and you never know whatthat opportunity might be.
So just be open to change or tothinking differently, whether
(17:43):
it be medical or career-wise orlife-wise or whatever.
Because I think when we getstuck in our sort of, you know,
our our um, well, if we get, youknow, our put if our blinders
are on and we can't look aroundus and see what else is out
there, sometimes we might missum great opportunities to do
amazing things.
Ashley (18:04):
That is so beautifully said.
I love that so much.
Um well, I was gonna talk abouthow obesity medicine is
evolving rapidly.
And and I do still want to talkabout that, but but not in the
way of new drugs, which ofcourse we're all hearing so much
about or new devices, um, butreally emerging, emerging
therapies, but more emergingoptions.
(18:24):
And this is where I want totalk about your pediatric weight
management telemedicinepractice, because, like you
said, you've always fought foryour patients, you've always
pursued patient advocacy.
And this is one way that you'redoing so.
It is so hard to talk topediatric patients and their
parents about weight.
And we've mentioned this on thepodcast before.
(18:45):
We had a nutritionist PA comeon and she works in pediatrics
and she's trained in this.
And she said she is constantlyhaving to reverse the
conversations that clinicians,PAs, MDs are already having.
So tell us why this pediatricweight management telemedicine
practice is so cruciallyimportant right now.
Dr. Nadler (19:03):
There just aren't enough programs out there to
treat the 15 million kids whoneed help.
And even in the big urbancenters where like I used to
work, we had a several hundredpatient waiting lists just to
get in the door.
Um, and that's the same storyit at all the tertiary care
(19:26):
children's hospitals that haveprograms, basically.
So my um my co-founder, mypartner in this used to run the
weight management clinic at uhChildren's Hospital Atlanta, and
I had mine in DC.
And we initially got togetherthinking, well, we're both 20
(19:47):
years plus into this, and wehave all this valuable
knowledge, and we were at thevery beginnings of it all when
it first started.
So let's form a consulting umcompany.
Well, it was just the two ofus, and we would go around and
just teach other people how todo it and help them build
programs locally.
And after a year of pitchingand not a single place being
(20:13):
interested in doing that, I wentback to business school as part
of my startup company.
So I actually was alsopitching, 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 Igot to a hospital
administrator, we had docs whowere interested.
Every time I got to a hospitaladministrator, it stopped.
(20:34):
Conversation stopped.
So my partner and I said, okay,well, if we can't teach people
how to do it, we have to justsuck 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, butnow we're going to show people
how to do it via telemedicine.
(20:56):
Because obviously thatincreases access because you
don't have to, if you're inrural America, you don't have to
drive two hours to get to youruniversity health center or
whatever, wherever you would go.
If you're in a big city, butyou're on the wrong side of that
city from the one hospital intown that has the clinic, and
you have to drive an hour andfight traffic and miss a half
(21:17):
day of work or miss school orwhatever.
We're just trying to take a lotof those barriers out of the
way.
And again, just increase accessto care, which is which is the
first step.
It's just getting in the door.
And then we can talk aboutwhat's right for you.
Lifestyle changes are right foreverybody, but don't always
achieve a lot of weight loss.
(21:37):
Medications, is that somethingthat your insurance even covers?
Is even a possibility.
Cause that's a whole notherepisode, if not, you know, whole
series.
Um, and then you know, surgery,which many people still view as
a last resort, which I don'tthink I don't think it should be
(22:00):
considered that way, but that'sstill how lots of people talk
about it.
So that's what we're trying todo.
I'll come back in a year andtell you how it went.
Ashley (22:08):
Yes, please do.
As we mentioned multiple timeson this show, just because I
work in dermatology, that doesnot mean that I don't have
questions or conversations aboutweight management with my
patients.
Sometimes it's underweight andwe're discussing how to gain
weight in a healthy way.
Sometimes it's overweight, andwe're discussing all of the
dermatologic conditions andconcerns that that are derived
(22:29):
because of that.
And so for me, to have aresource and a tool like this
available is is incredible.
And I and I'm I'm so gratefulfor you for really stepping up
and creating this because I knowit has been um uh it's been a
journey and uh a challenge, andI'm really excited to see where
it goes from here.
Dr.
Nadler, this has been such agreat conversation.
(22:50):
I'm sure a lot of people are sointerested in this telemedicine
practice in your YouTubechannel, in your book.
Dr. Nadler (22:56):
I actually have another project which we didn't
even talk about, which iscreating pediatric obesity uh
training modules for APPs, amongother folks.
Um, because there are gaps inin the education in med schools,
there needs to be more obesityeducation and pediatric obesity
education in residency programs.
There needs to be morepediatric obesity education.
(23:17):
So I'm trying to tackle allthose things all at once, which
you know, it's just why ADD is asuperpower and not a disease as
some other people think aboutit.
As long as you can control itfrom time to time.
Ashley (23:33):
It just opens the door and it's a perfect gateway to
having these really hardconversations that we don't have
to have alone because we haveyou and your incredible
resources.
So, Dr.
Evan Nadler, thank you so muchfor joining us today.
Dr. Nadler (23:46):
Hey, my pleasure, Ashley.
And I'm um obviously I'm happyto 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 toto give my opinion, whether it's
asked for or not.
Ashley (24:07):
I think that's fantastic, and I'm so grateful.
Thank you.
Thank you so much.
My pleasure.
Thank you so very much forlistening to this episode of
Shadow Me Next.
If you liked this episode, orif you think it could be useful
for a friend, please subscribeand invite them to join us next
Monday.
As always, if you have anyquestions, let me know on
Facebook or Instagram.
(24:27):
Access you want, stories youneed, you're always invited to
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