Ethical aspects of bariatric surgery in children and adolescents
Abstract
Obesity in children and adolescents is a global health challenge, the prevalence is increasing worldwide. Importantly, being overweight and obese are linked to a higher risk of death compared to being underweight. The objective of the present narrative review was to discuss the main ethical challenges and implications of bariatric surgery in childhood and adolescence. The surgical treatment of morbid obesity in children and adolescents is accepted and performed in most American and European hospitals. It is a therapeutic modality that can be considered in a selected group of adolescents with severe obesity who meet the requirements and recommendations, with the aim of improving their quality of life, reducing metabolic risks, associated diseases and early mortality. Bariatric surgery should not be indicated as an isolated procedure, but rather should be associated with a set of interventions aimed at strengthening permanent changes in lifestyle.
Downloads
References
Nittari G, Scuri S, Sagaro GG, Petrelli F, & Grappasonni I. Epidemiology of obesity in children and adolescents. Teamwork in Healthcare. 2020; twenty.
Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, & Gortmaker SL. Simulation of growth trajectories of childhood obesity into adulthood. New England J of Med. 2017; 377(22):2145-2153.
Jebeile H, Kelly AS, O'Malley G, & Baur , LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. The Lancet Diab & End. 2022; 10(5):351-365.
World Health Organization: WHO. Obesity and overweight. [cited 2024 Feb 20] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . 2021.
Apperley LJ, Blackburn J, Erlandson ‐ Parry K, Gait L, Laing P, & Senniappan S. Childhood obesity: A review of current and future management options. Clinical Endocrinology. 2022; 96(3):288-301.
Méndez-Hernánde z LD, et al. Effects of Strength Training on Body Fat in Children and Adolescents with Overweight and Obesity: A Systematic Review with Meta-Analysis. Children . 2022; 9(7):995.
Donate FI, Sánchez-Oliver AJ, Peinado PJB, Elvar JRH, Carmona WS, & Revenga JB. Guide for the design of intervention programs in the population with obesity: Positioning Document of the Physical Exercise Group of the Spanish Society for the Study of Obesity (SEEDO). Challenges: new trends in physical education, sports and recreation. 2023;(50):33-49.
Chao AM, Wadden TA, & Berkowitz RI. The safety of pharmacological treatment for pediatric obesity. Expert opinion on drug safety. 2018; 17(4):379-385.
Lennerz BS, et al. Bariatric surgery in adolescents and young adults—safety and effectiveness in a cohort of 345 patients. Inter j of obesity. 2014;38(3):334-340.
Khattab A, & Sperling MA. Obesity in adolescents and youth: the case for and against bariatric surgery. The J of pediatrics. 2019; 207:18-22.
Helmrath MA, Brandt ML, & Inge TH. Adolescent obesity and bariatric surgery. Surgical Clinics. 2006; 86(2):441-454.
Levine MD, Ringham RM, Kalarchian MA, Wisniewski L, Marcus MD. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord . 2001;30(3):318-28.
Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683-93.
Palermo TM, Dowd JB. Childhood obesity and human capital accumulation. Soc Sci Med. 2012;75(11):1989-98
Godoy CMDA, Magalhães GEJD, Santana MF, Correia SFBDM, & Silva JJD. Analysis of bioethics for the indications for bariatric surgery in children and adolescents. Magazine Bioethics . 2015;23:61 -69.
Inge TH, Garcia V, Daniels S, Langford L, Kirk S, Roehrig H. A multidisciplinary approach to the adolescent bariatric surgical patient. J Pediatr Surg. 2004;39(3):442-7.
Ibele AR, Mattar SG. Adolescent bariatric surgery. Surg Clin North Am. 2011;91(6):1339-51.
Amézquita MV, Baeza C, Ríos M, Francesetti V, Rybertt V, & Gutiérrrez M. Bariatric surgery in adolescents with severe obesity: Recommendations from the Nutrition Branch, Chilean Society of Pediatrics. Chilean journal of pediatrics. 2020;91(4):631-641.
Xanthakos SA, Daniels SR, & Inge, TH Bariatric surgery in adolescents: an update. Adolesc Med Clin . 2006;17(3):589-612.
Reyna VF, & Farley F. Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psycho science in the pub interest. 2006; 7(1):1-44.
Chamay -Weber C, Narring F, & Michaud PA. Partial eating disorders among adolescents: A review. J of adol health. 2005; 37(5): 416-426.
Roberts CA. Physical and psychological effects of bariatric surgery on obese adolescents: A review. Frontiers in pediatrics. 2021;8:591598 .
Pratt JS, Browne A, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surgery for Obesity and Relat Diseases. 2018; 14(7):882-901.
Beamish AJ, & Reinehr T. Should bariatric surgery be performed in adolescents?. European j of endocri . 2017; 176(4):D1-D15.
Arguedas-Arguedas O. Basic elements of bioethics in research. Costa Rican medical record. 2010;52(2):76-78.
Moreira LAC. Ethics and psychosocial aspects in relation to children and adolescents candidates for bariatric surgery . Bioethics Magazine. 2017; 25:101-110.
Eisenberg D, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. 2023;:3-14.
Katz AL, et al. Informed consent in decision-making in pediatric practice. Pediatrics. 2016;138(2).
Elkhoury D, Elkhoury C, & Gorantla VR. Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines. Cureus . 2023;15(4).
Qin ZH, et al. Quality evaluation of metabolic and bariatric surgical guidelines. Frontiers in Endocrinology. 2023;14:1118564
Beamish AJ, Harper ER, Järvholm K, Janson A, & Olbers T. Long-term outcomes following adolescent metabolic and bariatric surgery. The J of Clini Endocri & Metabo . 2023; dgad155.
Janson A, Järvholm K, Sjögren L, Dahlgren J, Beamish AJ, Gronowitz E, & Olbers T. Metabolic and Bariatric Surgery in Adolescents: For Whom, When, and How?. Hormone Research in Paediatrics . 2022;: 1-11.
Hofmann B. Bariatric surgery for obese children and adolescents: a review of the moral challenges. BMC medical ethics . 2013;14:1 -13.
Zerón A. Beneficence and non-maleficence. Magazine of the Mex Dental Association . 2019; 76(6):306-307.
Aguilar AAT, & Balarezo ELE. Literature review on definition, diagnostic criteria and treatment of metabolically healthy obese people. Lat Science Multidisciplinary Scientific Rev. 2022;6(6):2874-2885.
Martinelli V, Singh S, Politi P, Caccialanza R, Peri A, Pietrabissa A, & Chiappedi M. Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice. Int J of Envi Res and P Health. 2023;20(2):1232.
Ryder JR, et al. Factors associated with long term weight loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obe 2018;42:102 -07.
Hood M, et al. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med. 2016;39(6):1092-103.
Zeller M, Reiter- Purtill J. Psychosocial Issues in Adolescent Bariatric Surgery. The ASMBS Textbook of Bariatric Surgery. Integrated Health. 2015;(2):65-73.
Olbers T, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5 year , Swedish nationwide study. Lancet Diabetes Endocrinol . 2017;5:174 -83.
Coronado-Sarmiento JF, Palencia-Palencia JI, & Barraza-Leones OC. Bariatric surgery in pediatrics, what impact does it have? Literature review. Colombian Journal of Surgery. 2022;37(2):259-279.
López AL. Ethical and regulatory aspects of apheresis. Rev Mex de Medicina Transfu . 2022;14(S1 ):s 115-117.
Klebanoff MJ , Chhatwal J, Nudel JD, Corey KE, Kaplan LM, & Hur C. Cost-effectiveness of bariatric surgery in adolescents with obesity. JAMA surgery. 2017;152(2):136-141.
Nobili V, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J of pediatric gastro and nut. 2015;60(4):550-561.
Cabus L. Ethics and psychosocial aspects in child and adolescent candidates for bariatric surgery. Rev Bioet . 2017;25:101 -10.
Michalsky M & Inge T. Adolescent Bariatric Surgery. The ASMBS Textbook of Bariatric Surgery. New York: Springer. 2015;: 423-31.
Courcoulas AP, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374:113 -23.
Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am 2005;34:25 –33.
Coates PS, Bernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab 2004;89:1061 –1065.
Loux TJ, Haricharan RN, Clements RH, et al. Health-related quality of life before and after bariatric surgery in adolescents. J Pediatr Surg 2008; 43:1275–1279.
Zeller MH, et al. Psychosocial functioning improves following adolescent bariatric surgery. Obes Silver Spring 2009;17:985 –990.
Akamine AM, Ilias EJ. Why are psychological evaluation and preparation necessary for the patient candidate for bariatric surgery? Rev Assoc Med Bras 2013; 59:316–317.
Copyright (c) 2024 Luis Diego Méndez Hernández
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
