Adolescent bariatric surgery: ANZ guidance and recommendations

Vascular and Hypertension - Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
ANZ Journal of Surgery (Impact Factor: 1.12). 12/2011; 81(12):854-5. DOI: 10.1111/j.1445-2197.2011.05897.x
Source: PubMed
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    ABSTRACT: Background Bariatric 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. Discussion A 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. Summary Performing 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.
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    ABSTRACT: Due to the increased frequency of extreme obesity in adolescents and the inefficiency of usual treatments, bariatric surgery is now largely discussed as novel therapeutic option. However, it is important to be cautious due the specificity of this age since adolescence is characterized by specific nutritional requirements and important modifications of body image. According to international recommendations, it is critically important that obese adolescents have meticulous follow-up before bariatric surgery with global evaluation (medical, psychological, nutritional) during at least 6 months. Indication of such surgery is then discussed case to case with multidisciplinary expert team (doctors, surgeons, psychologists, dietitians, anesthesiologists). Until now, the type of surgery (adjustable gastric banding, sleeve gastrectomy or Roux-en-Y gastric bypass) is still largely discussed even if Roux-en-Y gastric bypass should be the better option due to its higher efficacy.
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