Table 1 Structure of themes and subthemes with additional representative quotes not included in the main text

Defining the burden of adolescent obesity

Statistics

“Officials at the World Health Organization (WHO) have warned that childhood obesity is one of the most serious global health challenges. Almost a third of UK pupils are already overweight by the age of 11.”

Causes of obesity

“He says that the rise in obesity is a "devastating" reflection of today's lifestyles: There is a substantial proportion of teens out there who have barely had a healthy meal in their life, are living couch-potato lifestyles and are spending hours playing computer games. […]"

“Surgery, of course, doesn't get to the root cause of why so many young Britons get fat in the first place: the proliferation of fast food outlets in deprived areas, sugary drinks and high-fat, high-sugar foods, poverty, fall-off in physical education in schools, the rise of a sedentary lifestyle and the allure of computer games and laptops."

“Furthermore, in predominantly Black and Latino North Philadelphia, almost three-fourths of the children were overweight.”

Sparking moral outrage

Stigmatizing obesity

“She admits she felt "some disdain for moms who let their kids drink soda or eat fast food" and "sometimes looked down on the moms of fat kids". There was no junk food in her house. Her kids drank only water and ate three healthy meals

Who’s to blame?

“I think the parents have to be blamed for overweight children, but they have to be helped. Although this is difficult for them—and we can understand chastising children and stopping them doing what they want is difficult—I'm afraid that's their responsibility. It comes with being a parent."

Surgery is a ‘quick fix’

“Experts worry that teens are opting for quick-fix operations such as gastric bypass, gastric bands and gastric balloons instead of changing their diet and doing more exercise.”

“One of the criticisms of weight-loss surgery is that it doesn't necessarily promote healthy eating: It's amazing what you can liquidise, Dr. XXX says”

Sensation-seeking

Headlines

“FAT KIDS OP PLEA—Overweight teenagers must have weight-loss surgery to stop 'obesity apocalypse', leading doctor claims"

Personal stories

“A teenager who watched her obese mother die of a heart attack has undergone weight loss surgery at 16 to avoid the same fate. XXX, was just a toddler when her mother YYY, suffered a heart attack at the family's home in ZZZ. Then aged three, XXX watched in horror as her mother YYY collapsed in front of her in 2004. YYY, who weighed around 300lbs, knocked over XXX toy kitchen as she fell to the floor and had passed away by the time paramedics brought her to hospital. Terrified she would also die young, the teenager—who weighed 275lbs (19st 6lbs)—had a vertical sleeve gastrectomy at 16, and has since lost 100lbs."

‘Radical’ surgery

“TEENAGERS as young as 16 have undergone radical NHS-funded weight loss surgery in Birmingham, worrying new figures show."

Raising ethical issues

Ability to give consent

“Even operating on teenagers raises issues that may not apply to adults. Can a miserable adolescent, for example, really can give informed consent to such a drastic, life-changing operation? And can a teenager be expected to commit to following the very restricted diet required after the surgery, not to mention taking the needed vitamins and minerals? Are they prepared to do that for the rest of their lives?”

Unmet need and disparity in access to care

“Only 0.2 per cent of people who meet the official criteria—that is, having a BMI over 30 with diabetes that is not adequately controlled by medication, or having a BMI over 40 regardless of diabetes—get offered bariatric surgery. I would like that changed to it being offered to more people who at least fit the criteria as drawn up by the National Institute for Health and Care Excellence"

Who should pay for surgery?

“The controversial operation, […], costs the NHS about £6,000 a time. […] Urgent action is needed and unless it happens the problem of obesity and related health costs will bankrupt the NHS.”