Childhood Obesity in the United Kingdom 105society. Eating provides pleasure and there is a social reward associated with
sharing food [106]. The drastic limitation in how much children can consume
after having bariatric surgery could further limit their ability to interact
socially – on a likely background that they are already socially isolated from a
lack of confidence. Micronutrient deficiency is a major concern in considering
the health outcomes of children who have had bariatric surgery [107, 108].
In a very elegant paper [109], Bjørn Hofmann (2013) explores the morally
relevant challenges surrounding bariatric surgery in children including:
Beneficence and Bariatric Surgery
He cautions that extrapolating results from adults might be flawed, with a
definite lack of concrete evidence. The conditions under which bariatric
surgery is performed are highly relevant for the outcome, for example
preoperative evaluation by a multidisciplinary team, bariatric surgery
competency with children and adolescents, postoperative care and follow up
and overall family support. Timing of surgery is also crucial as operations may
be performed too early -with a poor benefit/harm ratio; and too late -missing
relevant health benefits. There is also the question of “benefit for whom?”.
Safety and Risk
Bariatric surgery is associated with potentially serious risks and
recognized complications, and long-term safety and efficacy in children
remains largely unknown. Therefore, surgery should be reserved for only the
most severely obese and considered with extreme caution. Adverse events are
reported to be frequent even with very experienced surgeons therefore surgery
should be performed in specialised, high volume ‘quaternary’ centres. Very
few studies have investigated psychosocial effects of bariatric surgery, with
small numbers and short-term follow-up. Some studies have indicated high
rates of depression scores and negative self-acceptance in adolescents
following LAGB. Interestingly one study reported a significant rate of
unplanned pregnancy within the first 2 years following bariatric surgery in
adolescent female [110].
Autonomy and Compliance
Interventions aimed at managing obesity can be considered in the best
interest of the common good, since childhood obesity is expected to result in
significant health problems. However, some argue that such interventions may
become and infringe on personal autonomy and become paternalistic. Children
and adolescents can give assent to bariatric surgery while the adult with