Ethical considerations in the treatment of childhood obesity

Abstract

Rates of obesity in children and adolescents appear to be stabilizing, though the prevalence of extreme obesity in this population remains fairly consistent at 4%. Childhood obesity contributes to serious health complications, such as hypertension, orthopedic problems, hormonal imbalances, and adult obesity. Psychological, as well as social issues are also com- mon comorbid conditions to childhood obesity. Families and health care providers have limited options in regard to treating childhood obesity, some of which come with complications and potentially severe consequences. Currently, though there are no standardized recommendations or guidelines for the treatment of childhood obesity, it is routinely suggested that families and medical practitioners attempt to decrease weight through family-based treatment prior to the prescription of medications or bariatric surgery. Family-based treatment options include therapy, psychoeducation, and lifestyle modification for the entire family, rather than solely focused on the overweight child. Using pharmacotherapy to treat childhood obesity has shown to be effec- tive in decreasing body mass index, along with changes in nutrition and activity. Use of these medications for managing obesity comes with undesirable side effects involving gastrointestinal and cardiovascular systems and raises concerns about malnutrition. Although bariatric surgery has increased over the last several years and has shown some success in the treatment of obesity, minor to severe medical complications have surfaced. Low calcium levels, unexpected pregnan- cies, risk of death postoperation, and the development or resurfacing of psychological disorders, such as binge eating disorder and depression, have occurred after bariatric surgery. The health of the child, efficacy of weight loss alternatives, risks and benefits associated with those choices, and the decision-making ability of minors must all be considered when determining the best treatment option for obese children.