Bariatric surgery for obese children and adolescents: a review of the moral challenges

Abstract

BackgroundBariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process.DiscussionA wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.SummaryPerforming bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

“…Bariatric surgery may be a feasible alternative, with one study demonstrating reversal of type 2 diabetes in ten of 11 adolescents [37]. However, our study demonstrates that, if adhered to, a VLED may be as effective and possibly safer for youth, in whom the long-term effects of bariatric surgery, both physical and mental, are largely unknown [38]. Previous adult studies have also highlighted the potential of a VLED to facilitate the reversal of type 2 diabetes, prescribing energy intakes of 1680-2940 kJ/day over a duration lasting between 7 days and 16 weeks [10][11][12][13].…”

Ética e aspectos psicossociais em crianças e adolescentes candidatos a cirurgia bariátrica

“…; 3) Does the surgeon or clinician recommend the surgery, and the family and the patient consent? For Hofmann 13 , there are three basic questions to be answered to ensure beneficence in case of bariatric surgery for children and adolescents: 1) does bariatric surgery benefit the adolescents and children? ; 2) what are the long-term effects?…”

“…The aim is to minimize health problems, but there is no data on the safety, evolution and cost-effectiveness of the procedure among this age group. In addition, the lack of maturity of young people generates problems in relation to autonomy 13,14 .…”

“…They may not understand that they should adhere to a diet, perform physical activity and replenish vitamins and other elements that may not be absorbed because of the procedure 13 .…”

The obese child in the Intensive Care Unit. Update

“…1,2 In developing regions, such as Latin America, which is undergoing an epidemiological transition, the rate of obesity is high. More than 90% of childhood obesity is primary or exogenous, and caused by an excessive calorie intake in a setting of social determinants, such as poverty, lack of education and poor access to food.…”