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

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.

[1]  J. Pratt,et al.  Publisher Correction: 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 , 2022, Obesity Surgery.

[2]  M. Adileh,et al.  Laparoscopic Sleeve Gastrectomy in Adolescents: Ten-Years Follow-up , 2022, Obesity Surgery.

[3]  J. Pratt,et al.  2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. , 2022, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[4]  J. Greve,et al.  Innovative Bariatric Procedures and Ethics in Bariatric Surgery: the IFSO Position Statement , 2022, Obesity Surgery.

[5]  M. Bredella,et al.  One-Year Self-Reported Appetite Is Similar in Adolescents with Obesity Who Do or Do Not Undergo Sleeve Gastrectomy , 2022, Nutrients.

[6]  F. Guaraldi,et al.  Obesity and COVID-19 in Children and Adolescents: Reciprocal Detrimental Influence—Systematic Literature Review and Meta-Analysis , 2022, International journal of environmental research and public health.

[7]  W. Leclercq,et al.  Bariatric Surgery in Youth: the Perspective of Dutch Pediatricians, Parents, and Adolescents , 2021, Obesity Surgery.

[8]  Karen K. Wong,et al.  Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children , 2021, JAMA network open.

[9]  V. Calcaterra,et al.  Bariatric Surgery in Adolescents: To Do or Not to Do? , 2021, Children.

[10]  M. C. Jaklevic The Push for Earlier Bariatric Surgery for Adolescents With Severe Obesity. , 2021, JAMA.

[11]  H. Till,et al.  Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents , 2021, Children.

[12]  Frances A. Rickard,et al.  Memory and Executive Function in Adolescent and Young Adult Females with Moderate to Severe Obesity Before and After Weight Loss Surgery , 2021, Obesity Surgery.

[13]  J. Pratt,et al.  Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities , 2021, Obesity Surgery.

[14]  S. Flint Time to end weight stigma in healthcare , 2021, EClinicalMedicine.

[15]  C. Roberts Physical and Psychological Effects of Bariatric Surgery on Obese Adolescents: A Review , 2021, Frontiers in Pediatrics.

[16]  T. Inge,et al.  Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation. , 2020, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[17]  E. DeMaria,et al.  Comment on: Standardized Reporting of Comorbidity Outcome After Bariatric Surgery: Low Compliance With the ASMBS Outcome Reporting Standards Despite Ease of Use. , 2020, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[18]  I. McKillop,et al.  Outcomes of adolescents compared with young adults after bariatric surgery: an analysis of 227,671 patients using the MBSAQIP data registry. , 2020, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[19]  G. Silecchia,et al.  Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP , 2020, Surgical Endoscopy.

[20]  N. Bouvy,et al.  Current Opinions and Practices of Bariatric Surgery in Adolescents: A Survey among Pediatric Surgeons , 2020, European Journal of Pediatric Surgery.

[21]  A. Courcoulas,et al.  Suicidal thoughts and behaviors in adolescents who underwent bariatric surgery. , 2019, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[22]  A. Alqahtani,et al.  Endoscopic Sleeve Gastroplasty in 109 Consecutive Children and Adolescents With Obesity: Two-Year Outcomes of a New Modality. , 2019, The American journal of gastroenterology.

[23]  W. Jackson,et al.  Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass in the pediatric population: a MBSAQIP analysis. , 2019, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[24]  C. Apovian,et al.  Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Me , 2019, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[25]  Spencer W. Trooboff,et al.  Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis , 2019, Obesity Surgery.

[26]  E. Hazebroek,et al.  Weight Loss, Remission of Comorbidities, and Quality of Life After Bariatric Surgery in Young Adult Patients , 2019, Obesity Surgery.

[27]  A. Courcoulas,et al.  Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. , 2019, The New England journal of medicine.

[28]  R. Siegel,et al.  Pilot Testing of a Patient Decision Aid for Adolescents with Severe Obesity in US Pediatric Weight Management Programs within the COMPASS Network , 2019, International journal of environmental research and public health.

[29]  E. Nadler,et al.  Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability , 2019, Pediatrics.

[30]  A. Pietrabissa,et al.  Laparoscopic sleeve gastrectomy in an adolescent with Prader-Willi syndrome: psychosocial implications. , 2019, Nutrition.

[31]  C. Thompson,et al.  Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis , 2018, Obesity Surgery.

[32]  C. L. le Roux,et al.  How Ethical Is Our Current Delivery of Care to Patients with Severe and Complicated Obesity? , 2018, Obesity Surgery.

[33]  A. Courcoulas,et al.  A Multisite 2-Year Follow Up of Psychopathology Prevalence, Predictors, and Correlates Among Adolescents Who Did or Did Not Undergo Weight Loss Surgery. , 2018, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[34]  M. Neovius,et al.  BARIATRIC SURGERY & SUICIDE: RESULTS FROM TWO CONTROLLED MATCHED COHORT STUDIES , 2018, The lancet. Diabetes & endocrinology.

[35]  P. Scuffham,et al.  Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia. , 2017, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[36]  Jos M. van den Broek,et al.  Medical decision-making in children and adolescents: developmental and neuroscientific aspects , 2017, BMC Pediatrics.

[37]  L. A. C. Moreira Ética e aspectos psicossociais em crianças e adolescentes candidatos a cirurgia bariátrica , 2017 .

[38]  H. Cena,et al.  Association of a history of childhood-onset obesity and dieting with eating disorders , 2017, Eating disorders.

[39]  L. Bandini,et al.  Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children. , 2016, Disability and health journal.

[40]  M. Horlick,et al.  Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. , 2016, The New England journal of medicine.

[41]  M. Neovius,et al.  Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. , 2015, The lancet. Diabetes & endocrinology.

[42]  Markku Peltonen,et al.  Two‐year trends in psychological outcomes after gastric bypass in adolescents with severe obesity , 2015, Obesity.

[43]  R. Sysko,et al.  Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study. , 2015, European eating disorders review : the journal of the Eating Disorders Association.

[44]  M. van Ryn,et al.  Impact of weight bias and stigma on quality of care and outcomes for patients with obesity , 2015, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[45]  N. Bouvy,et al.  Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-analysis , 2015, Obesity Surgery.

[46]  N. Nguyen,et al.  The ASMBS Textbook of Bariatric Surgery , 2015 .

[47]  A. Hilbert,et al.  Psychosocial Status and Mental Health in Adolescents before and after Bariatric Surgery: A Systematic Literature Review , 2014, Obesity Facts.

[48]  M. Sarr Outcome of sleeve gastrectomy as a primary bariatric procedure (Br J Surg 2014; 101: 661–668) , 2014, The British journal of surgery.

[49]  F. Qureshi,et al.  Laparoscopic vertical sleeve gastrectomy for adolescents with morbid obesity. , 2014, Seminars in pediatric surgery.

[50]  C. Kraus,et al.  [Bariatric surgery in adolescents?]. , 2010, Versicherungsmedizin.

[51]  R. Galioto,et al.  Adherence and Weight Loss Outcomes in Bariatric Surgery: Does Cognitive Function Play a Role? , 2013, Obesity Surgery.

[52]  A. Kersting,et al.  Risk of completed suicide after bariatric surgery: a systematic review , 2013, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[53]  S. Bondada,et al.  Outcomes of bariatric surgery in adolescents , 2011, Current opinion in pediatrics.

[54]  D. Caniano Ethical issues in pediatric bariatric surgery. , 2009, Seminars in pediatric surgery.

[55]  J. Hebebrand,et al.  [Obesity and overweight]. , 2009, Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie.

[56]  C. Apovian,et al.  AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT , 2009, Obesity.

[57]  C. Galvani,et al.  Psychopathology in adolescents presenting for laparoscopic banding. , 2008, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[58]  C. Apovian,et al.  American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. , 2008, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[59]  D. Flum,et al.  Toward the rational and equitable use of bariatric surgery. , 2007, JAMA.

[60]  S Holm,et al.  Principles of Biomedical Ethics, 5th edn. , 2002 .

[61]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.