Conscience and Consent

(This continues from the previous post, on weight loss surgery and consent.)

Now think about another area. Courts are asked to decide if a 14-year-old girl can get birth control without parental consent. Even with consent, how old should a child be before puberty blockers and cross-sex hormones may be prescribed?

Cases are being argued about sexual reassignment surgery. Although not quite as impactful, bariatric surgery also changes the body irreversibly and brings lifelong consequences. A recent article about weight loss procedures says,

Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS.

[…] Ethical issues remain possible for each case… Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities.

What kinds of stressors could affect children and violate the principles of beneficence and non-maleficence? In some cases, there has seemed to be pressure to consent. Blogger s.e. smith wrote,

When your doctor is leaning on you to get the surgery, and so are your parents, and you’re being tormented at school for your weight, are you really making an independent choice?

Parents, too, have an additional fear in the form of multiple reported cases of fat children being seized by child services for being fat. Having a fat child is viewed as evidence of unfit parenting… Those parents might be forcing diets and exercise and other measures on their children, and could respond positively to a recommendation for weight loss surgery when these measures don’t work.

In regard to medical ethics and moral accountability, a surgeon in the field, Dr. Aparna Govil Bhasker, wrote about the danger of overzealous adults pressing for surgery that can lead to “unanticipated negative consequences several years into the future”:

These children are too immature to understand the gravity of the surgery being performed on them. For many years to come, they will not be able to apprehend the demands and exigencies of a bariatric procedure… It is also not justifiable to surgically modify healthy organs of an innocent toddler in absence of any clear evidence regarding safety and future outcomes.

There is a fear that over-enthusiastic media attention can have the effect of coercing parents into consenting to surgery for obese toddlers and children. Aside from the purely physical consequences, by agreeing to bariatric surgery, parents are signing up their children for a lifetime of surveillance, as if there were not enough of that sort of thing already. Maybe it would be better to direct more energy toward figuring out what causes runaway obesity, and dispense with the surgical option except in the most extreme cases.

Along with the need for a multi-disciplinary team in advance of any surgical intervention, everyone agrees on the necessity of long-term followup. This is crucial both for the patient’s sake, and for the collection of data necessary to make surgery safer and more effective for the next generation of patients.

Your responses and feedback are welcome!

Source: “The Role of Ethics Consultation in Decision Making for Bariatric Surgery in Pediatrics,”, 01/18/20
Source: “Fat Hatred Kills: Marketing Weight Loss Surgery to Children Has Got to Stop,”, 03/12/12
Source: “Bariatric Surgery — Should Children Have It?,”, 12/17/18
Image by Jon Collier/Flickr

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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