As the safety and efficacy of bariatric surgery for extremely obese adolescents is investigated, the ethical burdens of such surgery require significant attention. This article discusses specific ethical issues with the adolescent bariatric surgery population, and illustrates the role of the psychologist as an integrated part of the adolescent bariatric surgery team. This role goes beyond screening for psychiatric and behavioral “rule outs” that have been established in the adult bariatric surgery literature, and beyond recommendation and possible provision of assessment and intervention services for patients with behavioral health needs. Areas of informed consent, assent, and balancing issues of medical illness and psychological readiness are discussed in detail. The psychologist’s role in ensuring ethical practice across these areas is illuminated.