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parental responsibility gives consent. The general assumption is that parents
and responsible adults are best placed to know what is best for their child but,
for some obese children this can be questioned.
Informed Consent
There is an argument that it is difficult to provide information to families
in a way that ensures valid informed assent or consent because there is limited
evidence of long-term effectiveness and safety of bariatric procedures.
Children and adolescents suffering from depression may also have difficulties
with understanding and assessing information. Information provided can be
biased and parents and surgeons may be overly optimistic. There may be a
withholding of relevant information such as how surgery may change the life
of the person in significant ways, variability in treatment outcomes, and the
sometimes close relationships between health care professionals and industry
e.g., with regards devices and surgical banding techniques. Families often seek
surgery because they are desperate, have become scared, and feel judged by
society.
The above are only some of considerations that are very important when
bariatric surgery is being considered. In the UK NICE produced strict criteria
for which children should be considered for bariatric surgery [111]. The
guidelines were initially published in 2006, and were updated in 2014, and are
outlined in Table 5 below.
Table 5. NICE guidance on surgical interventions
for obese childrenSurgeryWhen to consider surgery* Surgical intervention is not generally recommended in children or young
people.
*Bariatric surgery may be considered for young people only in exceptional
circumstances, and if they have achieved or nearly achieved physiological
maturity.
*Surgery for obesity should be undertaken only by a multidisciplinary
team that can provide paediatric expertise in: preoperative assessment, including a risk-benefit analysis that includes