{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:18:42Z","timestamp":1787804322015,"version":"build-2784847793"},"reference-count":51,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2020,4,7]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>Prader-Willi syndrome (PWS) is one of the 25 syndromic forms of obesity, in which patients present\u2014in addition to different degrees of obesity\u2014intellectual disability, endocrine disturbs, hyperphagia and\/or other signs of hypothalamic dysfunction. In front of a severe\/extreme obesity and the failure of non-invasive treatments, bariatric surgery is proposed as a therapeutic option. The complexity of the clinical condition, which could affect the long-term effects of bariatric surgery, and the frequent association with a mild to severe intellectual disability raise some ethical concerns in the treatment of obese PWS adolescents. This article analyses these issues referring to the principles of healthcare ethics: beneficence\/non-maleficence (proportionality of treatments; minimisation of risks); respect of autonomy; justice. Based on these principles, three hypothetical scenarios are defined: (1) obese PWS adolescent, capable of making an autonomous decision; (2) obese PWS adolescent with a severe intellectual disability, whose parents agree with bariatric surgery; (3) obese PWS adolescent with a life-threatening condition and a severe intellectual disability, whose parents do not agree with bariatric surgery. The currently available evidence on efficacy and safety of bariatric surgery in PWS adolescents with extreme or severe obesity and the lack of adequate long-term follow-up suggests great caution even in a very life-threatening condition. Clinicians must always obtain a full IQ assessment of patients by psychologists. A multidisciplinary team is needed to analyse the clinical, psychological, social and ethical aspects and organise support for patient and parents, involving also the hospital ethical committee or, if necessary, legal authorities.<\/jats:p>","DOI":"10.1136\/medethics-2019-106038","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T17:19:48Z","timestamp":1588007988000},"page":"738-742","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Three scenarios illustrating ethical concerns when considering bariatric surgery in obese adolescents with Prader-Willi syndrome"],"prefix":"10.1136","volume":"46","author":[{"given":"Maria Luisa","family":"Di Pietro","sequence":"first","affiliation":[{"name":"Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanit\u00e0 Pubblica, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drieda","family":"Za\u00e7e","sequence":"additional","affiliation":[{"name":"Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanit\u00e0 Pubblica, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"issue":"12","key":"2026082403101460000_46.11.738.1","doi-asserted-by":"crossref","first-page":"3110","DOI":"10.1007\/s11695-017-2738-y","article-title":"Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-Analysis of 950 Patients with a Minimum of 3 years Follow-Up","volume":"27","author":"Shoar","year":"2017","journal-title":"Obes Surg"},{"issue":"6","key":"2026082403101460000_46.11.738.2","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1002\/oby.22196","article-title":"Treatment options for severe obesity in the pediatric population: current limitations and future opportunities","volume":"26","author":"Ryder","year":"2018","journal-title":"Obesity"},{"key":"2026082403101460000_46.11.738.3","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6939-14-18"},{"issue":"3","key":"2026082403101460000_46.11.738.4","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1053\/j.sempedsurg.2009.04.009","article-title":"Ethical issues in pediatric bariatric surgery","volume":"18","author":"Caniano","year":"2009","journal-title":"Semin Pediatr Surg"},{"issue":"1","key":"2026082403101460000_46.11.738.5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/pbc.23372","article-title":"An overview of mongenic and syndromic obesities in humans","volume":"58","author":"Chung","year":"2012","journal-title":"Pediatr Blood Cancer"},{"key":"2026082403101460000_46.11.738.6","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.genom.2.1.153"},{"issue":"2","key":"2026082403101460000_46.11.738.7","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/ajmg.a.36845","article-title":"A population-based profile of 160 Australians with Prader-Willi syndrome: trends in diagnosis, birth prevalence and birth characteristics","volume":"167A","author":"Lionti","year":"2015","journal-title":"Am J Med Genet A"},{"issue":"3","key":"2026082403101460000_46.11.738.8","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1590\/1984-0462\/;2018;36;3;00003","article-title":"Prader-willi syndrome: what is the general pediatrician supposed to do? - a review","volume":"36","author":"Passone","year":"2018","journal-title":"Rev Paul Pediatr"},{"issue":"2","key":"2026082403101460000_46.11.738.9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s11154-019-09502-2","article-title":"Prader- Willi syndrome: an uptodate on endocrine and metabolic complications","volume":"20","author":"Muscogiuri","year":"2019","journal-title":"Rev Endocr Metab Disord"},{"issue":"1","key":"2026082403101460000_46.11.738.10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/gim.2017.92","article-title":"Survival trends from the Prader-Willi syndrome association (USA) 40-year mortality survey","volume":"20","author":"Manzardo","year":"2018","journal-title":"Genet Med"},{"key":"2026082403101460000_46.11.738.11","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2147\/DMSO.S141352","article-title":"Obesity management in Prader-Willi syndrome: current perspectives","volume":"11","author":"Crin\u00f2","year":"2018","journal-title":"Diabetes Metab Syndr Obes"},{"key":"2026082403101460000_46.11.738.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2015.10.003"},{"key":"2026082403101460000_46.11.738.13","first-page":"80","article-title":"Clinical analysis of bariatric procedures in Prader-Willi syndrome","volume":"46","author":"Scheimann","year":"2008","journal-title":"JPNG"},{"key":"2026082403101460000_46.11.738.14","unstructured":"Beauchamp TL , Childress JF . 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