Adolescent bariatric surgery: ANZ guidance and recommendations

ArticleinANZ Journal of Surgery 81(12):854-5 · December 2011with4 Reads
DOI: 10.1111/j.1445-2197.2011.05897.x · Source: PubMed
    • "As already indicated, obesity is associated with psychiatric comorbidity77787980818283848586, reduced cognitive abilities [87,88], and verbal skills [89], affecting patient autonomy and competence to consent [90]. Obesity is related to anxiety, depression, and impaired self-esteem9192939495 as well as impaired social relationships [96]. "
    [Show abstract] [Hide abstract] 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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