Ethical issues in pediatric bariatric surgery

Performance of bariatric surgery in pediatric patients carries profound ethical burdens for all stakeholders: morbidly obese children and adolescents, their parents and families, pediatric physicians and surgeons, pediatric health care institutions, and society. The decision to proceed with a bariatric intervention should be made only after it is established that the patient's comorbidities could not be treated with less invasive means, the patient has a favorable risk/benefit profile, the patient and her/his family have received extensive preoperative counseling and given informed consent, and the pediatric bariatric team has a comprehensive system of short- and long-term care. The patient and her/his family should be counseled about the innovative aspects of the bariatric intervention, in which sustained weight loss and potential complications are unknown. The pediatric surgeons and their respective institutions that offer bariatric surgery should be enrolled in clinical research endeavors that assess outcomes and seek optimal treatment protocols.