HLSC220 Health Care Ethics Debate: Morbid Obesity and Surgery

This assignment presents a debate on the ethics of bariatric surgery for morbidly obese individuals. The student argues that individuals should demonstrate proactive weight loss efforts before undergoing surgery, emphasizing the importance of lifestyle changes for long-term success and the ethical principles of beneficence and non-maleficence. The student references studies to support the argument, highlighting potential complications of surgery without prior weight loss, such as weight regain, increased risk of diabetes and cardiovascular disease, and psychological issues. The debate also addresses the ethical principle of autonomy, acknowledging the importance of patient education. The student concludes that while bariatric surgery can be effective, self-initiated weight loss efforts should be monitored to ensure the best patient outcomes. References include studies by Kissler and Settmacher (2013), Schauer et al. (2017), and Liebl, Barnason and Brage Hudson (2016), among others, to support the arguments.

Running head: HEALTH CARE ETHICS
Health Care Ethics
Name of the Student
Name of the University
Author Note

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HEALTH CARE ETHICS
We think that people who are morbidly obese should not have access to the surgery
until they have intentionally lost weight. In order to elaborate our thoughts over the negative
side of this topic, we would like to highlight few evidences.
Obesity has become a global health problem that is associated with several life-
threatening diseases and development of physical disability like type 2 diabetes mellitus
(T2DM) and coronary artery. It also hampers the dignity of the affected person as morbidly
obese individual suffers from social bullying and social stigmatization and isolation. Thus in
order to enter into the health lifestyle, dignity and to reduce the vulnerability of developing
chronic non-communicable diseases, initiatives of weight loss is important. There are few
studies like the study conducted by Kissler and Settmacher (2013) stated that long-term
results achieved through the application of the weight loss therapies like diet, medications
and exercise are comparatively poor. Thus in order to promote faster weight loss and to retain
the change for a considerable period of time, bariatric surgery is recommended. Bariatric
surgery is the most effective treatment of the obese individuals for promoting substantial yet
sustained eight losses while improving or simultaneously resolving the obesity related co-
morbidities and thus helping to reduce the mortality. Under this context, there are also
contrasting views. For example, the review conducted by Wolfe, Kvach and Eckel (2016)
stated that in order to promote sustainable weight-loss after conducting bariatric surgery, it is
important to maintain a healthy lifestyle habit otherwise, even after the conduction of the
surgery there lays a probability of gaining the additional weight.
In reference to this, I would like to highlight few similar points in order to strengthen
my position in this discussion. Schauer et al. (2017) are of the opinion that the majority of the
patients who have selected the option of bariatric surgery as a mean of achieving healthier
weight were successful however, for some patients this expensive process is not beneficial.
Immediate long-term success of bariatric surgery depends on the ability of the individuals to

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incorporate the lifestyle change and the associated behavioural change. Such that the patients
who are not successful in maintaining a healthy lifestyle by taking proactive initiatives are
bound to gain weight even after the conduction of the bariatric surgery. Sudden gain in
weight after conduction of the surgery is detrimental for the body and also increases the
chances of developing pre-surgical depression, binge eating, emotion-triggered eating and
poor self-esteem due to poor body image. All these psychological factors further promote
gain in additional body mass. Thus to ensure the bio-ethics of beneficence or for the
promotion of good, patients self-initiatives of weight-loss must be monitored before initiation
of the surgery.
To highlight the after-effects of the weight-gain post bariatric surgery, Liebl,
Barnason and Brage Hudson (2016) conducted a study and showed that an individual who
have gained weight after the weight-loss surgery are more vulnerable in developing type 2
diabetes mellitus and cardiovascular disease in comparison to the person who are obese and
have not conducted that surgery. This increased rate of vulnerability increases the rate of
mortality and morbidity among this obese group of individuals. Under the context of a
bariatric surgery Cooper et al. (2015) stated that weight gain is one of the most common
complications among the patients who are vulnerable to weigh-gain or have high cholesterol
level post the bariatric surgery. The mean weight-gain among the individuals who have
undertaken the weight-loss surgery is 23.4% of the maximum weight-loss. Thus to reduce the
gain in mean-weight and to prevent the chances of harm, self-active initiative must be
monitored. This opinion is further supported by the ethics of non-maleficence. However,
going against the wish of an individual and not to conduct the surgery must hamper the ethics
of autonomy. In such cases patient education about side-effects of sudden bariatric surgery
must be explained. This will help to secure ethics of autonomy and will also help to promote
good to the patient.

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Thus I just want to say that, I am not talking against the weight-loss surgery or
questioning the efficacy of the weight-loss surgery is not my point of discussion, I am just
trying to highlight my point that weight-loss surgery must be initiated only when the
concerned person is has taken certain active initiatives for facilitating weight-loss like
following healthy diet plan or regular practice of mild to moderate physical activity. Physical
activity and diet are two indispensible requirements for weight-loss and has been proved
since the time immoral. Though these two initiatives might not be a comprehensive solution
for morbid obesity management but bringing a change in the lifestyle habit is helpful for
retaining the reduced weight. Thus a person who has taken self-initiatives for reducing weight
knows the difficulty of the physical effort conducted for weight loss and thus will more likely
to abide by the healthy lifestyle habits after the bariatric surgery and thereby reducing the
chances of the weight gain. Moreover, self-initiative for losing weight also helps to highlight
the desperation of that person to lose weight or to stay fit or to have a positive body image
and these proactive initiatives will be helpful in retaining the reduced body weight. In relation
to this, Liebl, Barnason and Brage Hudson (2016) further reported that in order to maintain
the weight-loss an individual must seek out and must be surrounded by a positive family and
peer support influences. Having a positive support helps in providing an opportunity for the
individual to place the personal healthcare needs as the main priority and thereby helping to
retain the balanced body weight.
It is certainly true that bariatric surgery is an effective invasive technique for the
promotion of weight-loss among the morbidly obese individuals, however, I have dubious
regarding the overall success of the bariatric surgery among the individuals who have not
taken any self-initiatives for the weight-loss promotion. Thus to secure the basic human rights
of the people for receiving safe and effective care, self-weight-loss initiatives must be
monitored. It cannot be denied that healthy lifestyle initiatives are not always comprehensive

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in facilitating weight-loss among morbidly obese patients within a certain period of time
however, healthy lifestyle interventions like controlled and regulated intake of meal, healthy
diet plan and regular practice of mild to moderate physical activity is helpful in retaining and
managing the reduced weight.

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References
Carter, M.C., Burley, V.J. and Cade, J.E., 2017. Weight loss associated with different
patterns of self-monitoring using the mobile phone app My Meal Mate. JMIR mHealth and
uHealth, 5(2), p.e8.
Cooper, T.C., Simmons, E.B., Webb, K., Burns, J.L. and Kushner, R.F., 2015. Trends in
weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obesity
surgery, 25(8), pp.1474-1481.
Kissler, H.J. and Settmacher, U., 2013, January. Bariatric surgery to treat obesity.
In Seminars in nephrology (Vol. 33, No. 1, pp. 75-89). WB Saunders.
Liebl, L., Barnason, S. and Brage Hudson, D., 2016. Awakening: a qualitative study on
maintaining weight loss after bariatric surgery. Journal of clinical nursing, 25(7-8), pp.951-
961.
Schauer, P.R., Bhatt, D.L., Kirwan, J.P., Wolski, K., Aminian, A., Brethauer, S.A.,
Navaneethan, S.D., Singh, R.P., Pothier, C.E., Nissen, S.E. and Kashyap, S.R., 2017.
Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. New
England Journal of Medicine, 376(7), pp.641-651.
Wolfe, B.M., Kvach, E. and Eckel, R.H., 2016. Treatment of obesity: weight loss and
bariatric surgery. Circulation research, 118(11), pp.1844-1855.