Toward an intergenerational model of metabolic and bariatric surgery: reframing the household as the unit of care.

Obesity is a chronic, relapsing disease that increasingly spans generations within households, yet contemporary metabolic and bariatric surgery (MBS) models remain oriented toward individuals or single-generation patients. A growing body of evidence demonstrates that obesity risk, behaviors, and treatment responses cluster within family systems, and that MBS produces measurable metabolic and behavioral effects among untreated spouses, partners, and children. Concurrently, decades of pediatric research confirm that caregiver engagement and integration is one of the strongest determinants of successful obesity treatment. Together, these observations support a paradigm shift toward an intergenerational, family-centered model of MBS, in which the household becomes the unit of care. This perspective synthesizes evidence supporting the biological, behavioral, and environmental interdependence of obesity within families and outlines a comprehensive framework for implementing household-level bariatric care. Core components include integrated pediatric-adult clinical infrastructure; combined multidisciplinary teams trained across the age spectrum; harmonized protocols for evaluation, education, and follow-up; coordinated scheduling and workflow alignment; and family-based behavioral strategies that promote shared goals, consistent routines, and mutual accountability. Operational and policy innovations, such as cross-departmental agreements, unified electronic health records, and coordinated billing can facilitate sustainable implementation. We further identify research priorities, including quantifying metabolic ripple effects among untreated family members, evaluating bundled household-level interventions, and developing validated metrics to assess changes in the home environment. Treating the household as the patient offers a promising strategy to enhance medical obesity treatment, surgical durability, improve adherence, and disrupt intergenerational transmission of obesity. As obesity increasingly presents as a family condition, an intergenerational MBS model may help realign treatment with the realities of lived experience and improve outcomes across generations.