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Contemporary Ethical Considerations for Pediatric Metabolic and Bariatric Surgery
Marla A Sacks1, Catherine Hunter2, Patrick J Javid3
1Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
Background:
The prevalence of pediatric obesity continues to increase dramatically. Though metabolic and bariatric surgery (MBS) is efficacious and is supported by high-quality data in this population, it remains underutilized. This paper aims to discuss current ethical concerns, considerations, and controversies of pediatric MBS.
Methods/Results:
Three case studies are utilized to illustrate ethical issues related to pediatric MBS: 1) a teenager with obesity and an unsupportive parent; 2) a teenager with morbid obesity and developmental delay; and 3) a young child with severe liver damage from hepatic steatosis.
Conclusions:
The prevalence of pediatric obesity is rising exponentially with more cases resistant to lifestyle modifications and medical therapies. Metabolic and bariatric surgery (MBS) in children is efficacious and should prompt thoughtful multi-disciplinary discussion to best help the patient regardless of racial, ethnic, or socioeconomic status. Decision making involves consideration of patient assent, parent/guardian consent, and balance of current and future risk. Providers caring for patients should utilize "obesity-friendly" language to lessen stigma.
Level Of Evidence:
Level V.
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