Too big to swallow

The failure of current treatment approaches to severe obesity has resulted in significant investment by the scientific community to develop new treatments for this challenging health problem. Any new treatment must be scientifically tested to determine its potential role and any innovation in healthcare can be associated with moral and ethical challenges. This reflective piece is based on the experience of running the first randomised controlled trial to compare laparoscopic adjustable gastric banding to an intensive behaviourally-based intervention in adolescents with severe obesity during which many moral and ethical concerns were articulated by other health professionals. Five different types of responses are described (preventers, druggies, deferrers, slippery slopers and simplifiers). While raising important concerns, these responses also deflect attention from the urgent need to develop and test new treatments for the most severely obese adolescents. The stigma of obesity is posed as an underlying yet unaddressed issue.