Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice

Abstract

Obesity is increasingly prevalent among adolescents. Clinical and research data support the use of bariatric surgery (BS) as a treatment option for severely obese adolescents, with good results in terms of weight loss, improvement or resolution of comorbidities, and compliance to follow up. Nevertheless, concerns still remain, with significant disparities among countries and ethical concerns mainly raised by performing an irreversible and invasive procedure in adolescence, with potential life-long alterations. In this context, the purpose of this narrative review was to discuss the main current ethical challenges in performing BS in adolescence and to inform appropriate clinical management in the field. The core ethical principles of autonomy, beneficence, nonmaleficence, and justice were revised in terms of patient-centered healthcare through the lens of psychosocial implications. The review concludes with a discussion regarding the potential directives for future research for effective, patient-centered, and ethical management of obesity in the adolescent population.

Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology

“…Bariatric surgery is considered very selectively for example by the American Society of Metabolic and Bariatric Surgery in adolescents with body mass index (BMI) ≥ 35 kg/m2 with major comorbidities or with a BMI ≥ 40 kg/m2 with minor comorbidities, However, as discussed by Martinelli et al in a recent review "the use of bariatric surgery in adolescent patients is still limited, with significant disparities among countries. Reasons include ethical concerns raised by performing an irreversible and invasive procedure in adolescence, with potential life-long alterations" [42]. In conclusion, on the one hand there is an increasingly general agreement in treating adolescent obesity by deepening knowledge on the use of new generations of drugs and/or bariatric surgery combined with behavioral therapies that help change lifestyles and on the other hand, the undoubted difficulties of this path lead us to insist on programs for the global prevention of obesity.…”