Sacks Marla A, Hunter Catherine, Javid Patrick J, Shakhsheer Baddr A
Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
Division of Pediatric Surgery, Oklahoma Children's Hospital, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Pediatr Surg. 2025 Mar;60(3):161988. doi: 10.1016/j.jpedsurg.2024.161988. Epub 2024 Oct 9.
The prevalence of pediatric obesity continues to increase dramatically. Though metabolic and bariatric surgery (MBS) is efficacious and is supported by high-quality data in this population, it remains underutilized. This paper aims to discuss current ethical concerns, considerations, and controversies of pediatric MBS.
METHODS/RESULTS: Three case studies are utilized to illustrate ethical issues related to pediatric MBS: 1) a teenager with obesity and an unsupportive parent; 2) a teenager with morbid obesity and developmental delay; and 3) a young child with severe liver damage from hepatic steatosis.
The prevalence of pediatric obesity is rising exponentially with more cases resistant to lifestyle modifications and medical therapies. Metabolic and bariatric surgery (MBS) in children is efficacious and should prompt thoughtful multi-disciplinary discussion to best help the patient regardless of racial, ethnic, or socioeconomic status. Decision making involves consideration of patient assent, parent/guardian consent, and balance of current and future risk. Providers caring for patients should utilize "obesity-friendly" language to lessen stigma.
Level V.
儿童肥胖的患病率持续急剧上升。尽管代谢与减重手术（MBS）在该人群中有效且有高质量数据支持，但仍未得到充分利用。本文旨在探讨儿童MBS当前的伦理问题、考量因素及争议。
方法/结果：采用三个案例研究来说明与儿童MBS相关的伦理问题：1）一名肥胖青少年及不支持手术的家长；2）一名患有病态肥胖和发育迟缓的青少年；3）一名因肝脂肪变性导致严重肝损伤的幼儿。
儿童肥胖的患病率呈指数级上升，越来越多的病例对生活方式改变和药物治疗有抵抗性。儿童代谢与减重手术（MBS）是有效的，应促使进行深入的多学科讨论，以最好地帮助患者，无论其种族、民族或社会经济地位如何。决策过程涉及考虑患者的同意、家长/监护人的同意以及当前和未来风险的平衡。照顾患者的医疗服务提供者应使用“对肥胖友好”的语言以减轻污名化。
V级。
