Abstract
Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity.
Similar content being viewed by others
References
Beauchamp, T.L., and J.F. Childress. 2009. Principles of biomedical ethics, 6th edition. Oxford: Oxford University Press.
Berghmans, R., D. Dickenson, and R. ter Meulen. 2004. Mental capacity: In search of alternative perspectives. Health Care Analysis 12(4): 251–263.
Bolt, L.L.E., and M. Schermer. 2009. Psychopharmaceutical enhancers: Enhancing identity? Neuroethics 2(2): 103–111.
Caniano, D.A. 2009. Ethical issues in pediatric bariatric surgery. Seminars in Pediatric Surgery 18(3): 186–192.
Capella, J.F., and R.F. Capella. 2003. Bariatric surgery in adolescence. Is this the best age to operate? Obesity Surgery 13(6): 826–832.
de Vries, J. 2007. The obesity epidemic: Medical and ethical considerations. Science and Engineering Ethics 13(1): 55–67.
Ebbeling, C.B., D.B. Pawlak, and D.S. Ludwig. 2002. Childhood obesity: Public health crisis, common sense cure. The Lancet 360(9331): 473–482.
Fried, M., V. Hainer, A. Basdevant, et al. 2007. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obesity Surgery 17(2): 260–270.
Fried, M. 2008. Bariatric surgery in pediatrics—when and how? International Journal of Pediatric Obesity 3(2): 15–19.
Garcia, V.F. 2005. Adolescent bariatric surgery: Treatment delayed may be treatment denied. Pediatrics 115(3): 822.
Guest, G., A. Bunce, and L. Johnson. 2006. How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1): 59–82.
Health Council of the Netherlands. 2003. Overweight and obesity. The Hague: Health Council of the Netherlands.
Hofmann, B. 2010a. Stuck in the middle: The many moral challenges with bariatric challenges. The American Journal of Bioethics 10(12): 3–11.
Hofmann, B. 2010b. The encompassing ethics of bariatric surgery. The American Journal of Bioethics 10(12): W1–W2.
Inge, T.H., N.F. Krebs, V.F. Garcia, et al. 2004. Bariatric surgery for severely overweight adolescents: Concerns and recommendations. Pediatrics 114(1): 217–223.
Iqbal, C.W., S. Kumar, A.D. Iqbal, and M.B. Ishitani. 2009. Perspectives on pediatric bariatric surgery: Identifying barriers to referral. Surgery for Obesity and Related Diseases 5(1): 88–93.
Livingston, E.H. 2010. Surgical treatment of obesity in adolescence. The Journal of the American Medical Association 303(6): 559–560.
Ludwig, D.S. 2007. Childhood obesity—the shape of things to come. The New England Journal of Medicine 357(23): 2325–2327.
Morse, J.M. 2000. Determining sample size. Qualitative Health Research 10(1): 3–5.
Ogden, J., and Z. Flanagan. 2008. Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people. Patient Education and Counseling 71(1): 72–78.
Ogden, J., I. Bandara, H. Cohen, et al. 2001. General practitioners’ and patients’ models of obesity: Whose problem is it? Patient Education and Counseling 44(3): 227–233.
Schermer, M., L.L.E. Bolt, R. de Jongh, and B. Olivier. 2009. The future of psychopharmaceutical enhancements: Expectations and policies. Neuroethics 2(2): 75–87.
Treadwell, J.R., F. Sun, and K. Schoelles. 2008. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Annals of Surgery 248(5): 763–776.
van Geelen, S.M., L.L.E. Bolt, and M.J.H. van Summeren. 2010. Moral aspects of bariatric surgery for obese children and adolescents: The urgent need for empirical-ethical research. The American Journal of Bioethics 10(12): 30–32.
Woolford, S.J., S.J. Clark, A. Gebremariam, M.M. Davis, and G.L. Freed. 2010. To cut or not to cut: Physicians’ perspectives on referring adolescents for bariatric surgery. Obesity Surgery 20(7): 937–942.
Ziebland, S., and A. McPherson. 2006. Making sense of qualitative data analysis: An introduction with illustrations from DIPEx (personal experiences of health and illness). Medical Education 40(5): 405–414.
Acknowledgments
This study was supported by a grant from the Netherlands Organization for Health Research and Development (ZonMw, Grant No. 141020004).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Geelen, S.M., Bolt, I.L.E., van der Baan-Slootweg, O.H. et al. The Controversy Over Pediatric Bariatric Surgery. Bioethical Inquiry 10, 227–237 (2013). https://doi.org/10.1007/s11673-013-9440-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11673-013-9440-0