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Ethical Dilemmas in Obesity Prevention and Management

Later this week, I have been invited to present the opening address at the 7th Annual Meeting of the Association for the Study of Obesity on the Island of Ireland in Dublin. The topic I was asked to speak about, concerns some of the ethical dilemmas we face in trying to address the prevention and management of obesity. The following is the abstract of my presentation, which will hopefully stimulate some interesting discussion on this important issue: Obesity is highly stigmatised and people living with obesity face bias and discrimination in virtually all societal settings including education, professional life, and even health care. Although obesity is now increasingly recognised as a complex chronic disease (not unlike hypertension or type 2 diabetes), both the public health and clinical approaches to obesity prevention and management embrace a rather simplistic narrative of “eat-less-move-more”, which fails to fully acknowledge that complex interaction between environmental and neurobiological mechanisms play a large role in determining body shape and size, much of which is beyond the control of the individual. Thus, there is currently no proven public health approach to reducing obesity in a population, nor does diet and exercise help sustain long-term weight loss in the vast majority of people living with obesity. Despite an abundance of weight loss attempts and a diversity of diets and weight-loss programs, sustained weight loss over years remains the exception – for most people, weight regain (relapse) is just a matter or time.  This is in contrast to medical or surgical treatments of obesity, which have proven to be far superior to behavioural interventions alone in sustaining long-term weight loss. Given that obesity now affects almost one in four adults in most Western countries, health administrators face important dilemmas regarding how to best provide access to effective treatments to the millions of people living with this chronic disease. In this regard, learning from other chronic diseases like type 2 diabetes can be helpful and will be discussed. @DrSharmaBerlin, Germany

Ethical Dilemmas In Obesity Prevention

Who, in the light of the obesity epidemic and its myriad consequences, could possibly object to public health messages and other measures that would target obesity? Aren’t messages to increase physical activity and eat healthier, even if provided with a ‘nudge’ (fat tax, BMI report cards, etc.), a reasonable and necessary step in the interest of promoting public health and tackling obesity? It turns out that things are less clear than you may think, especially if you consider the ‘ethics’ of such measures and their implications for those, who these measures seek to educate and change for the better. Thus, a comprehensive analysis of the surprisingly problematic ethics of some of the public health approaches to obesity prevention, by the medical ethicist Inez de Beaufort and colleagues, from the University of Rotterdam, published in the latest issue of OBESITY REVIEWS, makes a most enlightening and thought-provoking read. In their paper, the researchers look at 60 recently reported interventions or policy proposals targeting overweight or obesity and systematically evaluate their ethically relevant aspects. As the authors point out, while efforts to counter the rise in overweight and obesity, such as taxes on certain foods and beverages, limits to commercial advertising, a ban on chocolate drink at schools or compulsory physical exercise for obese employees, may appear ‘ethical’ as they are aimed at improving individual and public health, enabling informed choice and diminishing societal costs, they also raise potential ethical objections against such efforts. The long list of potentially ethically problematic aspects identified include: Effects on physical health (of proposed interventions) are uncertain or unfavourable; There are negative psychosocial consequences including uncertainty, fears and concerns, blaming and stigmatization and unjust discrimination; Inequalities are aggravated; Inadequate information is distributed; The social and cultural value of eating is disregarded; People’s privacy is disrespected; The complexity of responsibilities regarding overweight is disregarded; Interventions infringe upon personal freedom regarding lifestyle choices and raising children, regarding Freedom of private enterprise or regarding policy choices by schools and other organizations. Whether or not the ‘ethical’ incentives to combat the obesity epidemic should ‘automatically’ override the potential ethical constraints, is less than clear. The complexity of some of these ‘well meant’ initiatives can have unintended ethically problematic consequences: e.g. ‘demonizing’ candy, fast food, or chocolate milk can ostracize the child, who consumes these foods because of socioeconomic or other constraints. Oversimplistic and unrealistic messages about the benefits of diet… Read More »

Weekend Roundup, November 4, 2011

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Ethical Dilemmas in Obesity Prevention Did Weight Bias Play a Role in Access to H1N1 Vaccinations? Blood Glucose Levels Modulate Neural Control of Appetite Arthritis Report Targets Obesity Of Potato Starch Learning to Fly Targeting Genes and Life After the Nobel Prize Have a great Sunday! (or what is left of it) AMS Edmonton, Alberta You can now also follow me and post your comments on Facebook