Metabolic bariatric surgery (MBS) for adolescents is an effective treatment for severe obesity, but its clinical application is fraught with controversy and challenges. From an ethical perspective, careful consideration must be given to balancing patient autonomy with guardian involvement and the suitability of surgery for special populations. Regarding patient selection, criteria for factors such as BMI thresholds and preoperative health status require further clarification, and multi-dimensional assessments of physiological and psychological factors complicate decision-making. Regarding surgical procedure selection, long-term outcomes vary among different procedures, and the safety and efficacy of certain procedures require further research validation. Postoperative complications may include nutritional deficiencies, impacts on bone health, and the need for reoperation, while adolescents’ compliance also poses challenges to long-term outcomes. While cost-benefit ratios may become evident in the long term, initial costs are high. These issues highlight the necessity of multidisciplinary collaboration and individualized management in adolescent MBS to better align with adolescents’ growth and developmental characteristics and health needs, thereby providing robust safeguards for surgical safety and long-term efficacy.
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