The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.
Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
The rationale for policy intervention to reduce obesity rates appears compelling. Justification for intervening in the case of children is particularly strong, and precedent suggests that society will more readily accept appropriate restrictions to youth behavior.
Residents can be better prepared to treat patients who are obese by understanding that care as an expression of the core principles of professionalism: responsibility, self-regulation, patient-centered care, and teamwork.