Department of Pediatrics, University Medical Center Utrecht, Lundlaan 6, Utrecht, The Netherlands.
J Bioeth Inq. 2013 Jun;10(2):227-37. doi: 10.1007/s11673-013-9440-0. Epub 2013 Apr 13.
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.
尽管传统治疗方法的报告收效甚微，并且越来越多的证据表明成人减肥手术的有效性，但医疗保健专业人员和普通大众仍然认为对肥胖儿童和青少年进行减肥手术存在争议。本文描述了一项探索性的定性研究，涉及肥胖专家、病态肥胖青少年以及父母，并确定了他们对儿科减肥手术的态度和规范信念。对肥胖病因的看法——肥胖是否主要被视为一种医学状况，还是更多地被视为一种社会心理问题——似乎影响了专家对减肥手术作为治疗选择的可接受性的规范意见，也影响了父母对他们能够影响孩子健康以及孩子能够控制自己病情的感受，以及青少年对治疗的胜任感和动力。此外，那些认为肥胖是可以自己控制的父母和青少年更倾向于非手术治疗，反之亦然。存在冲突的态度和规范观点——例如，关于疾病概念、个人对健康的影响、动机以及是否可能进行仔细的知情同意程序——在接受儿科肥胖减肥手术方面起着重要作用。
