Ethical Dimensions of Bariatric Surgery: A Narrative Review of Principles, Challenges, and Practice Implications Publisher Pubmed



Soltani H R ; Toolabi K ; Sadat Safavi S A ; Najjari K ; Latif A
Source: Obesity Surgery Published:2026

Abstract

Metabolic and bariatric surgery (MBS) is among the most effective interventions for severe obesity, with contemporary outcomes best reported as percentage total weight loss (%TWL), yet it raises ethical challenges distinct from many other surgical disciplines. This SANRA-guided narrative review synthesizes ethical issues across the adult bariatric patient journey using Beauchamp and Childress’ four principles: autonomy, beneficence, non-maleficence, and justice. Key tensions include safeguarding consent validity amid obesity stigma and desperation bias; balancing patient autonomy with assessment of co-occurring psychiatric conditions, including a reported five-year cumulative incidence of new alcohol use disorder symptoms of approximately 21% after Roux-en-Y gastric bypass; addressing long-term nutritional, psychological, and follow-up obligations; adapting communication for collectivist contexts; and engaging the implications of obesity management medications, telemedicine, and artificial intelligence. Ethical bariatric practice requires multimodal consent, individualized multidisciplinary candidacy assessment, equity-oriented access policies, and durable systems for long-term postoperative care. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.