Stuck in the middle: The many moral challenges with bariatric surgery

American Journal of Bioethics

Volumn 10, Issue 12, 2010, Pages 3-11

  Hofmann, Bjørn ^a  

^a NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY   (Norway)

Author keywords

Autonomy; Bariatric surgery; Discrimination; Justice; Overweight; Prejudice

Indexed keywords

ARTICLE; BARIATRIC SURGERY; COST BENEFIT ANALYSIS; CULTURAL FACTOR; DECISION MAKING; DOCTOR PATIENT RELATION; ECONOMICS; ETHICS; HEALTH; HEALTH CARE DISPARITY; HEALTH CARE POLICY; HEALTH DISPARITY; HUMAN; INFORMED CONSENT; MORBID OBESITY; PERSONAL AUTONOMY; RISK REDUCTION; SOCIAL PSYCHOLOGY;

BARIATRIC SURGERY; CHOICE BEHAVIOR; COST-BENEFIT ANALYSIS; CULTURAL CHARACTERISTICS; ETHICAL ANALYSIS; HEALTH POLICY; HEALTH STATUS DISPARITIES; HEALTHCARE DISPARITIES; HUMANS; INFORMED CONSENT; OBESITY, MORBID; PERSONAL AUTONOMY; PHYSICIAN-PATIENT RELATIONS; PREJUDICE; RISK REDUCTION BEHAVIOR; WORLD HEALTH;

EID: 78650259872     PISSN: 15265161     EISSN: 15360075     Source Type: Journal    
DOI: 10.1080/15265161.2010.528509     Document Type: Article

References (97)

1. Album, D., and S. Westin. 2008. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science & Medicine 66(1): 182-188.
2. Allison, D. B., M. Downey, R. L. Atkinson, C. J. Billington, G. A. Bray, R. H. Eckel, E. A. Finkelstein, M. D. Jensen, and A. Tremblay. 2008. Obesity as a disease: A white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity 16(6): 1161-1177.
3. Alverdy, J. C., V. Prachand, B. Flanagan, W. A. Thistlethwaite, M. Siegler, M. Garfinkel, P. Angelos, S. Agarwal, and H. Santry. 2009. Bariatric surgery: A history of empiricism, a future in science. Journal of Gastrointestinal Surgery 13(3): 465-477.
4. American Society for Metabolic & Bariatric Surgery. 2009. Website. Available at: http://www.asbs.org (accessed December 5, 2009).
5. Andreyeva, T., R. M. Puhl, and K. D. Brownell. 2008. Changes in perceived weight discrimination among Americans: 1995-1996 through 2004-2006. Obesity 16: 1129-1134.
6. Aphramor, L. 2005. Is a weight-centred health framework salu-togenic? Some thoughts on unhinging certain dietary ideologies. Social Theory and Health 3: 315-340.
7. Arterburn, D. E., M. L. Maciejewski, and J. Tsevat. 2005. Impact of morbid obesity on medical expenditures in adults. International Journal of Obesity 29:334-339.
8. Blakemore, A. I., and P. Froguel. 2008. Is obesity our genetic legacy? Journal of Clinical Endocrinology and Metabolism 93(11 suppl. 1): S51-S56.
9. Bockelbrink, A., Y. Stoeber, S. Roll, C. Vauth, S. N. Willich, and W. Greiner. 2008. Evaluation of medical and health economic effectiveness of bariatric surgery (obesity surgery) versus conservative strategies in adult patients with morbid obesity. Cologne: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information (DAHTA DIMDI).
10. Bockelbrink, A., Y. Stöber, S. Roll, C. Vauth, S.N. Willich, and W. Greiner. 2008. Evaluation of medical and health economic effectiveness of bariatric surgery (obesity surgery) versus conservative strategies in adult patients with morbid obesity. Köln: German Agency for HTA of German Institute of Medical Documentation and Information. Available at: http://portal.dimdi.de/de/hta/htaberichte/hta203summary en.pdf (accessed January 4, 2010).
11. Brown, I. 2006. Nurses' attitudes towards adult patients who are obese: Literature review. Journal of Advanced Nursing 53(2): 221-232.
12. Brownell, K. D., R. M. Puhl, M. B. Schwartz, and L. Rudd (eds.). 2005. Weight bias: Nature, consequences, and remedies. New York: Guilford Press.
13. Buchwald, H., Y. Avidor, E. Braunwald, et al. 2004. Bariatric surgery: A systematic review and meta-analysis. Jurnal of the American Medical Association 292: 1724-1737.
14. Buchwald, H., Consensus Conference Panel. 2005. Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third-party payers. Journal of the American College of Surgeons 200: 593-604.
15. Campos, P. 2004. The obesity myth: Why America's obsession with weight is hazardous to your health. New York: Gotham Books.
16. Campos, P., A. Saguy, P. Ernsberger, E. Oliver, and G. Gaesser. 2006. The epidemiology of overweight and obesity: Public health crisis or moral panic. International Journal of Epidemiology 35: 55-60.
17. Caniano, D. A. 2009. Ethical issues in pediatric bariatric surgery. Seminars in Pediatric Surgery 18(3): 186-192.
18. Cappelen, A., and O. F. Norheim. 2005. Responsibility in health care-A liberal egalitarian approach. Journal of Medical Ethics 31: 476-480.
19. Colquitt, J. L., J. Picot, E. Loveman, and A. J. Clegg. 2009. Surgery for obesity. Cochrane Database of Systematic Reviews, Issue 2, Article CD003641. doi:10.1002/14651858.CD003641.pub3.
20. Cowan, G. S., Jr., M. L. Hiler, and C. Buffington. 1999. Criteria for selection of patients for bariatric surgery. European Journal of Gastroenterology and Hepatology 11(2): 69-75.
21. Cowan, G. S., Jr. 1998. What do patients, families and society expect from the bariatric surgeon? Obesity Surgery 8(1): 77-85.
22. Day, P. 2005. What is the evidence for the safety and effectiveness of surgical and non-surgical interventions for patients with morbid obesity? Christchurch: New Zealand Health Technology Assessment (NZHTA) 40.
23. de Vries, J. 2007. The obesity epidemic: medical and ethical considerations. Science and Engineering Ethics 13(1): 55-67.
24. Dutta, S., J. Morton, E. Shepard, et al. 2006. Methamphetamine use following bariatric surgery in an adolescent. Obesity Surgery 16: 780-782.
25. EUnetHTA Work Package 4. 2008. HTA core model for medical and surgical interventions v 1.0r. Available at: http://www.eunethta.net/upload/WP4/Final%20Deliverables/HTA%20Core%20Model%20 for%20Medical%20and%20Surgical%20Interventions%201%200r.pdf (accessed December 16, 2009).
26. Fallon, E. M., M. Tanofsky-Kraff, A. C. Norman, et al. 2005. Health-related quality of life in overweight and nonoverweight black and white adolescents. Journal of Pediatrics 147: 443-450.
27. Finkelstein, E., I. C. Fiebelkorn, and G. Wang. 2005b. The costs of obesity among fulltime employees. American Journal of Health Promotion 20: 45-51.
28. Finkelstein, E. A., C. J. Ruhm, and K. M. Kosa. 2005a. Economic causes and consequences of obesity. Annual Review of Public Health 26: 239-257.
29. Finkelstein, E. A., I. C. Fiebelkorn, and G. Wang. 2003. National medical spending attributable to overweight and obesity: How much, and who's paying? Health Affairs suppl. W3: 219-226.
30. Flum, D. R., T. V. Khan, and E. P. Dellinger. 2007. Toward the rational and equitable use of bariatric surgery. Journal of the American Medical Association 298: 1442-1444.
31. Gard, M., and J. Wright. 2005. The obesity epidemic: Science, morality and ideology. London: Routledge.
32. Grilo, C. M., R. M. Masheb, M. Brody, C. Toth, C. H. Burke-Martindale, and B. S. Rothschild. 2005. Childhood maltreatment in extremely obese male and female bariatric surgery candidates. Obesity Research 13: 123-130.
33. Groven, K. S., M. Råheim, and G. Engelsrud. 2010. "My quality of life is worse compared to my earlier life." Living with chronic problems after weight loss surgery. International Journal of Qualitative Studies on Health and Well-being 5: 5553.
34. Hell, E., and K. Miller. 2002. [Bariatric surgery-Stereotypes and paradigms]. Zentralblatt Chirurgie 127(12): 1032-1034 (in German).
35. Hensrud, D. D., and S. Klein. 2006. Extreme obesity: A new medical crisis in the United States. Mayo Clinic Proceedings 81(suppl. 10): S5-S10.
36. Herndon, A. M. 2005. Collateral damage from friendly fire? Race, nation, class and the "war against obesity." Social Semiotics 15(2): 127-141.
37. Hofmann, B. 2001. The technological invention of disease. Journal of Medcial Ethics: Medical Humanities 27: 10-19.
38. Hofmann, B. 2005a. Toward a procedure for integrating moral issues in health technology assessment. International Journal of Health Technology Assessment 21(3): 312-318.
39. Hofmann, B. 2005b. On value-judgements and ethics in health technology assessment. Poiesis & Praxis: International Journal of Technology Assessment and Ethics of Science 3(4): 277-295.
40. Ikonen, T. S., H. Anttila, H. Gylling, et al. 2009. Sairaalloisen lihavu-uden leikkaushoito. Helsinki.
41. Inge, T. H, N. F. Krebs, V. F. Garcia, J. A. Skelton, K. S. Guice, R. S. Strauss, C. T. Albanese, M. L. Brandt, L. D. Hammer, C. M. Harmon, T. D. Kane, W. J. Klish, K. T. Oldham, C. D. Rudolph, M. A. Helmrath, E. Donovan, and S. R. Daniels. 2004. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics 114(1): 217-223.
42. Inge, T. H. 2006. Bariatric surgery for morbidly obese adolescents: is there a rationale for early intervention? Growth Hormone & IGF Research 16(suppl. A): S15-S19.
43. Inge, T.H., S.A. Xanthakos, and M.H. Zeller. 2007. Bariatric surgery for pediatric extreme obesity: Now or later? International Journal of Obesity 31(1): 1-14.
44. Jacobs, P., A. Ohinmaa, S. Klarenbach, et al. 2006. Costing of alternative interventions for the treatment of morbid obesity. Edmonton, AB: Institute of Health Economics, Available at: www.ihe. ca/documents/WP%2006-01.pdf (accessed December 16, 2009).
45. Jamal, M. K., E. J. DeMaria, J. M. Johnson, B. J. Carmody, L. G. Wolfe, J. M. Kellum, and J. G. Meador. 2006. Insurance-mandated preoper-ative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Surgery for Obesity and Related Diseases 2(2): 122-127.
46. Kaminsky, J., and D. Gadaleta. 2002. A study of discrimination within the medical community as viewed by obese patients. Obesity Surgery 12(1): 14-18.
47. Lau, D. C. W., J. D. Douketis, K. M. Morrison, et al. 2006. Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. Canadian Medical Association Journal 176(suppl. 8): 1-117.
48. Levine, M. D., R. M. Ringham, M. A. Kalarchian, L. Wisniewski, and M. D. Marcus. 2001. Is family-based behavioral weight control appropriate for severe pediatric obesity? International Journal of Eating Disorders 30: 318-328.
49. Livingston, E. H. 2005. Hospital costs associated with bariatric procedures in the United States. American Journal of Surgery 190: 816-820.
50. Livingston, E. H., and A. S. Fink. 2003. Quality of life: cost and future of bariatric surgery. Archives of Surgery 138: 383-388.
51. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. 2009. Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine 361: 445-454.
52. Madan, A. K., D. S. Tichansky, and R. J. Taddeucci. 2007. Postoperative laparoscopic bariatric surgery patients do not remember potential complications. Obesity Surgery 17(7): 885-888.
53. Maggard, M. A., L. R. Shugarman, M. Suttorp, et al. 2005. Meta-analysis: Surgical treatment of obesity. Annals of Internal Medicine 142: 547-559.
54. Martin, M., A. Beekley, R. Kjorstad, and J. Sebesta. 2009. Socioeco-nomic disparities in eligibility and access to bariatric surgery: A national population-based analysis. Surgery for Obesity and Related Diseases. Available at: http://www.sciencedirect.com/science?ob=ArticleURL&udi=B7MD3-4WSRF94-3&user=10&rdoc=1&fmt=&orig=search&sort=d&docanchor=&view=c&searchStrId=1153929632&rerunOrigin=google&acct=C000050221&version=1&urlVersion=0&userid=10&md5=cba42cad02f92bbfd545623a6d845f39 (accessed January 4, 2010).
55. Medical Advisory Secretariat. 2005. Bariatric surgery. Toronto: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care. Available at: http://www.health.gov.on.ca/english/provid-ers/program/mas/tech/reviews/sum baria 010105.html (accessed January 4, 2010).
56. Medical Advisory Secretariat. 2005. Bariatric surgery: An evidence-based analysis. Ontario Health Technology Assessment Series 5. Available at: www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/revbaria 010105.pdf (accessed December 8, 2009).
57. Monaghan, L.F.2005a.Bighandsomemen,bearsandothers:Virtual constructions of "fat male embodiment." Body and Society 11(2): 81-111.
58. Monaghan, L. F. 2005b. Discussion piece: A critical take on the obesity debate. Social Theory and Health 3: 302-314.
59. Munoz, D. J., M. Lal, E. Y. Chen, et al. 2007. Why patients seek bariatric surgery: A qualitative and quantitative analysis of patient motivation. Obesity Surgery 17(11): 1487-1491.
60. National Health Service. 2007. Surgery for obesity. Evidence Note 19. Available at: www.nhshealthquality.org
61. Nichols, C., and M. H. Oermann. 2005. An evaluation of bariatric Web sites for patient education and guidance. Gastroenterological Nursing 28(2): 112-117.
62. Oakley, J. 2007. Patients and disclosure of surgical risk. In Principles of health care ethics, ed. R. E. Ashcroft, A. Dawson, H. Draper, and J. R. McMillan, 319-324 Chichester: John Wiley & Sons.
63. Ogden, J., and Z. Flanagan. 2008. Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people. Patient Education and Counseling 71(1): 72-78.
64. Ogden, J., C. Clementi, and S. Aylwin. 2006. The impact of obesity surgery and the paradox of control: a qualitative study. Psychology & Health 21(2): 273-293.
65. Oliver, J. E. 2006. The politics of pathology: How obesity became an epidemic disease. Perspectives in Biology and Medicine 49(4): 611-627.
66. Padwal, R., A. Kezouh, M. Levine, et al. 2007. Long-term persistence with orlistat and sibutramine in a population-based cohort. International Journal of Obesity 31: 1567-1570.
67. Padwal, R. S., and A. M. Sharma. 2009. Treating severe obesity: Morbid weights and morbid waits. Canadian Medical Association Journal 181(11): 777-778.
68. Picot, J., J. Jones, J. L. Colquitt, et al. 2009. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technology Assessment 13(41).
69. Pomeranz, J. L. 2008. A historical analysis of public health, the law, and stigmatized social groups: The need for both obesity and weight bias legislation. Obesity 16(suppl. 2): S93-S103.
70. Pratt, J. S., C. M. Lenders, E. A. Dionne, A. G. Hoppin, G. L. Hsu, T. H. Inge, D. F. Lawlor, M. F. Marino, A. F. Meyers, J. L. Rosenblum, and V. M. Sanchez. 2009. Best practice updates for pediatric/adolescent weight loss surgery. Obesity 17(5): 901-910.
71. Puhl, R., and K. D. Brownell. 2001. Bias, discrimination, and obesity. Obesity Research 9(12): 788-805.
72. Puhl, R. M., and C. A. Heuer. 2009. The stigma of obesity: A review and update. Obesity 17(5): 941-964.
73. Purnell, J. Q., and D. R. Flum. 2009. Bariatric surgery and diabetes: Who should be offered the option of remission? Journal of the American Medical Association 301(15): 1593-1595.
74. Raper, S. E., and D. B. Sarwer. 2008. Informed consent issues in the conduct of bariatric surgery. Surgery for Obesity and Related Diseases 4(1): 60-68.
75. Revill, J. 2006. NHS rations anti-obesity surgery. The Observer September 10. Available at: www.guardian.co.uk/society/2006/ sep/10/health.medicineandhealth (accessed July 9, 2009).
76. Roberts, L. W., R. Balon, and J. Coverdale. 2009. Ethics commentary: Fundamentals of life. Focus 7: 469-471.
77. Rosik, C. H. 2005. Psychiatric symptoms among prospective bariatric surgery patients: Rates of prevalence and their relation to social desirability, pursuit of surgery, and follow-up attendance. Obesity Surgery 15: 677-683.
78. Rothman, K. J. 2008. BMI-related errors in the measurement of obesity. International Journal of Obesity 32: S56-S59.
79. Salant, T., and H. P. Santry. 2006. Internet marketing of bariatric surgery: contemporary trends in themedicalization of obesity. Social Science & Medicine 62(10): 2445-2257.
80. Sarwer, D. B., N. I. Cohn, L. M. Gibbons, et al. 2004. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg 14: 1148-1156.
81. Saxena, S., G. Ambler, T. J. Cole, and A. Majeed. 2004. Ethnic group differences in overweight and obese children and young people in England: Cross sectional survey. Archives of Disease in Childhood 89: 30-36.
82. Shekelle, P. G., S. C. Morton, M. A. Maglione, et al. 2004. Pharmacological and surgical treatment of obesity. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ).
83. Shell, R. E. 2002. The hungry gene. The inside story of the obesity industry. New York: Grove Press.
84. Sjostrom, L., K. Narbro, C. D. Sjostrom, et al. 2007. Effects of bariatric surgery onmortalityin Swedish obese subjects. New England Journal of Medicine 357: 741-752.
85. Stearns, P. N. 1997. Fat history. Bodies and beauty in the modern West. New York: New York University Press.
86. Sturm, R. 2002. The effects of obesity, smoking, and drinking on medical problems and costs. Health Affairs 21: 245-253.
87. Sundbom, M., and B. M. Karlson. 2008. Low mortality in bariatric surgery 1995 through 2005 in Sweden, in spite of a shift to more complex procedures. Obesity Surgery 19: 1697-1701.
88. Svetkey, L. P., V. J. Stevens, P. J. Brantley, et al. 2008. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. Journal of the American Medical Association 299: 1139-1148.
89. Saarni S., B. Hofmann, K. Lampe, et al. 2008. Ethical analysis to improve decision-making on health technologies. Bulletin of the World Health Organization 86(8): 617-623.
90. Throsby, K. 2007. "How could you let yourself get like that?" Stories of the origins of obesity in accounts of weight loss surgery. Social Science & Medicine 65(8): 1561-1571.
91. Tjepkema, M. 2008. Adult obesity in Canada: Measured height and weight. In Nutrition: Findings from the Canadian Community Health Survey 2004. Issue 1. Ottawa, ON: Statistics Canada. Catalog number 82-620-MWE2005001. Available at: www.statcan.ca/english/research/82-620-MIE/2005001/articles/adults/aobesity.htm (accessed December 7, 2009).
92. Uli, N., S. Sundararajan, and L. Cuttler. 2008. Treatment of childhood obesity. Current Opinion in Endocrinology, Diabetes and Obesity 15(1): 37-47.
93. U.S. Department of Veterans Affairs (VATAP). 2003. Technology Assessment Unit, Office of Patient Care Services, Bariatric surgery: Summary of INAHTA reviews. Technology Assessment Unit, Office of Patient Care Services, U.S. Department of Veterans Affairs (VATAP).
94. van Hout, G. C., I. van Oudheusden, and G. L. van Heck. 2004. Psychological profile of the morbidly obese. Obesity Surgery 14: 579-588.
95. Wilde, M. L. 2004. Bioethical and legal implications of pediatric gastric bypass. Willamette Law Review 40(3): 575-625.
96. Wilding, J. P. H. 2006. Pathophysiology and aetiology of obesity. Medicine 34: 501-505.
97. Zeller, M. H., and A. C. Modi. 2006. Predictors of health-related quality of life in obese youth. Obesity 14: 122-130.