Ethical Issues in Bariatric Surgery

  • Antonio J. Torres
  • Oscar Cano-Valderrama
  • Inmaculada Domínguez-Serrano


Obesity is nowadays considered an epidemic disorder all around the world. Bariatric surgery is the only effective treatment for patients with morbid obesity; therefore the number of bariatric procedures has being increasing for years. The increase of obesity and bariatric surgery has provoked new ethical concerns that had never been seen before. The aim of this chapter was to discuss these ethical issues.

First of all, ethical concerns related to obesity are discussed, such as excessive medicalization of obesity and importance of physical appearance. Discrimination associated with obesity and bariatric surgery is also an important issue.

Then, ethical problems related to bariatric surgery are discussed. One of the most important issues is information and informed consent. Another important concern is access to bariatric surgery. Some patients cannot afford the surgery or have to use medical tourism in order to have this surgery performed. Bariatric surgery in children and teenagers is one of the most difficult ethics concerns that has been explained in this chapter. Others issues such as innovation, education, or body contouring surgery are also discussed.


Bariatric surgery Obesity Ethics concerns Ethical issues Medicalization Informed consent and discrimination 


  1. 1.
    Scopinaro N. The IFSO and obesity surgery throughout the world. International Federation for the Surgery of Obesity. Obes Surg. 1998;8:3–8.CrossRefGoogle Scholar
  2. 2.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27:2279–89.CrossRefGoogle Scholar
  3. 3.
    Peralta M, Ramos M, Lipert A, Martins J, Marques A. Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand J Public Health. 2018.
  4. 4.
    Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32(Suppl 7):S93–7.CrossRefGoogle Scholar
  5. 5.
    Schneider PL, Li Z. Ethical challenges in the care of the inpatient with morbid obesity. Narrat Inq Bioeth. 2016;6:143–52.CrossRefGoogle Scholar
  6. 6.
    de Vries J. The obesity epidemic: medical and ethical considerations. Sci Eng Ethics. 2007;13:55–67.CrossRefGoogle Scholar
  7. 7.
    Brandon AR, Puzziferri N, Sadler JZ. Stuck in the middle: what should a good society do? Am J Bioeth. 2010;10:18–20.CrossRefGoogle Scholar
  8. 8.
    Macgregor AM, Macgregor CC. Economic theory and physician behavior in bariatric surgery. Obes Surg. 2000;10:4–6.CrossRefGoogle Scholar
  9. 9.
    Long MT, Fox CS. The Framingham Heart Study – 67 years of discovery in metabolic disease. Nat Rev Endocrinol. 2016;12:177–83.CrossRefGoogle Scholar
  10. 10.
    Hayes M, Baxter H, Muller-Nordhorn J, Hohls JK, Muckelbauer R. The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review. Obes Rev. 2017;18:1398–411.CrossRefGoogle Scholar
  11. 11.
    Mazer LM, Azagury DE, Morton JM. Quality of life after bariatric surgery. Curr Obes Rep. 2017;6:204–10.CrossRefGoogle Scholar
  12. 12.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRefGoogle Scholar
  13. 13.
    Saarni SI, Anttila H, Saarni SE, et al. Ethical issues of obesity surgery – a health technology assessment. Obes Surg. 2011;21:1469–76.CrossRefGoogle Scholar
  14. 14.
    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9:788–805.CrossRefGoogle Scholar
  15. 15.
    Karris L. Prejudice against obese renters. J Social Pshycol. 1977;101:2.Google Scholar
  16. 16.
    Vartanian LR, Smyth JM. Primum non nocere: obesity stigma and public health. J Bioeth Inq. 2013;10:49–57.CrossRefGoogle Scholar
  17. 17.
    Newhook JT, Gregory D, Twells L. ‘Fat girls’ and ‘big guys’: gendered meanings of weight loss surgery. Sociol Health Illn. 2015;37:653–67.CrossRefGoogle Scholar
  18. 18.
    Klein D, Najman J, Kohrman AF, Munro C. Patient characteristics that elicit negative responses from family physicians. J Fam Pract. 1982;14:881–8.PubMedGoogle Scholar
  19. 19.
    Price JH, Desmond SM, Krol RA, Snyder FF, O’Connell JK. Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med. 1987;3:339–45.CrossRefGoogle Scholar
  20. 20.
    Rouleau CR, Rash JA, Mothersill KJ. Ethical issues in the psychosocial assessment of bariatric surgery candidates. J Health Psychol. 2016;21:1457–71.CrossRefGoogle Scholar
  21. 21.
    Hofmann B. Stuck in the middle: the many moral challenges with bariatric surgery. Am J Bioeth. 2010;10:3–11.CrossRefGoogle Scholar
  22. 22.
    Puia A, Puia IC, Cristea PG. Ethical considerations in bariatric surgery in a developing country. Clujul Med. 2017;90:268–72.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Madan AK, Tichansky DS, Taddeucci RJ. Postoperative laparoscopic bariatric surgery patients do not remember potential complications. Obes Surg. 2007;17:885–8.CrossRefGoogle Scholar
  24. 24.
    Persson K. Why Bariatric surgery should be given high priority: an argument from law and morality. Health Care Anal. 2014;22:305–24.CrossRefGoogle Scholar
  25. 25.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
  26. 26.
    Terranova L, Busetto L, Vestri A, Zappa MA. Bariatric surgery: cost-effectiveness and budget impact. Obes Surg. 2012;22:646–53.CrossRefGoogle Scholar
  27. 27.
    Upadhyay J, Farr O, Perakakis N, Ghaly W, Mantzoros C. Obesity as a disease. Med Clin North Am. 2018;102:13–33.CrossRefGoogle Scholar
  28. 28.
    Glenn NM, Raine KD, Spence JC. Mandatory weight loss during the wait for bariatric surgery. Qual Health Res. 2015;25:51–61.CrossRefGoogle Scholar
  29. 29.
    Wild B, Hunnemeyer K, Sauer H, et al. Sustained effects of a psychoeducational group intervention following bariatric surgery: follow-up of the randomized controlled BaSE study. Surg Obes Relat Dis. 2017;13:1612–8.CrossRefGoogle Scholar
  30. 30.
    Buchwald H. Revisional metabolic/bariatric surgery: a moral obligation. Obes Surg. 2015;25:547–9.CrossRefGoogle Scholar
  31. 31.
    Dixon JB, Logue J, Komesaroff PA. Promises and ethical pitfalls of surgical innovation: the case of bariatric surgery. Obes Surg. 2013;23:1698–702.CrossRefGoogle Scholar
  32. 32.
    De Ville K. Bariatric surgery, ethical obligation, and the life cycle of medical innovation. Am J Bioeth. 2010;10:22–4.CrossRefGoogle Scholar
  33. 33.
    Shikora SA. A call for maintaining ethical behavior in bariatric surgery. Obes Surg. 2012;22:849–50.CrossRefGoogle Scholar
  34. 34.
    Durkin N, Desai AP. What is the evidence for paediatric/adolescent bariatric surgery? Curr Obes Rep. 2017;6:278–85.CrossRefGoogle Scholar
  35. 35.
    Hofmann B. Bariatric surgery for obese children and adolescents: a review of the moral challenges. BMC Med Ethics. 2013;14:18.CrossRefGoogle Scholar
  36. 36.
    van Geelen SM, Bolt IL, van der Baan-Slootweg OH, van Summeren MJ. The controversy over pediatric bariatric surgery: an explorative study on attitudes and normative beliefs of specialists, parents, and adolescents with obesity. J Bioeth Inq. 2013;10:227–37.CrossRefGoogle Scholar
  37. 37.
    Snyder J, Crooks VA. Medical tourism and bariatric surgery: more moral challenges. Am J Bioeth. 2010;10:28–30.CrossRefGoogle Scholar
  38. 38.
    Snyder J, Crooks VA. New ethical perspectives on medical tourism in the developing world. Dev World Bioeth. 2012;12:iii–vi.CrossRefGoogle Scholar
  39. 39.
    Gilmartin J, Bath-Hextall F, Maclean J, Stanton W, Soldin M. Quality of life among adults following bariatric and body contouring surgery: a systematic review. JBI Database System Rev Implement Rep. 2016;14:240–70.CrossRefGoogle Scholar
  40. 40.
    Altieri MS, Yang J, Park J, et al. Utilization of body contouring procedures following weight loss surgery: a study of 37,806 patients. Obes Surg. 2017;27:2981–7.CrossRefGoogle Scholar
  41. 41.
    Athavale R. Morbidly obese and super-obese women should have surgery refused for benign conditions: FOR: a holistic approach is required to tackle the obesity pandemic and its effects. BJOG. 2016;123:224.CrossRefGoogle Scholar
  42. 42.
    Mahoney C, Vincent K, Crosbie EJ. Morbidly obese and super-obese women should have surgery refused for benign conditions: AGAINST: refusing surgery is both legally and morally wrong. BJOG. 2016;123:224.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Antonio J. Torres
    • 1
  • Oscar Cano-Valderrama
    • 1
  • Inmaculada Domínguez-Serrano
    • 1
  1. 1.Department of SurgeryHospital Clínico San CarlosMadridSpain

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