Ethical Dimensions of Bariatric Surgery: A Narrative Review of Principles, Challenges, and Practice Implications

Metabolic and bariatric surgery (MBS) is among the most effective interventions for severe obesity, with contemporary outcomes best reported as percentage total weight loss (%TWL), yet it raises ethical challenges distinct from many other surgical disciplines. This SANRA-guided narrative review synthesizes ethical issues across the adult bariatric patient journey using Beauchamp and Childress' four principles: autonomy, beneficence, non-maleficence, and justice. Key tensions include safeguarding consent validity amid obesity stigma and desperation bias; balancing patient autonomy with assessment of co-occurring psychiatric conditions, including a reported five-year cumulative incidence of new alcohol use disorder symptoms of approximately 21% after Roux-en-Y gastric bypass; addressing long-term nutritional, psychological, and follow-up obligations; adapting communication for collectivist contexts; and engaging the implications of obesity management medications, telemedicine, and artificial intelligence. Ethical bariatric practice requires multimodal consent, individualized multidisciplinary candidacy assessment, equity-oriented access policies, and durable systems for long-term postoperative care.