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.

Berlin, Germany