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The obesity epidemic: medical and ethical considerations

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Abstract

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as ‘the obesity epidemic’. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children.

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Notes

  1. Diabetes type II, or diabetes mellitus, normally develops at later stages in life, and is caused by chronic excessive energy consumption. For reasons unknown, patients develop resistance against insulin resulting in inability to metabolise sugars. Diabetes of this type is an important consequence of overweight and obesity. It stands against Diabetes type I, in which patients do not produce insulin at all. This type of diabetes can be hereditary or result from disease and infection, and can be solved by the regular administration of insulin. It is normally manifested early in life, whereas diabetes Type II traditionally occurred only late in life (hence it is also referred to as old people’s diabetes). Type I diabetes does not result from the chronic over-consumption of energy.

  2. The Body Mass Index is a relation between the weight and height of an individual, and is considered a relatively adequate approximation to classify weight [6]. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2) (44).

  3. The WHO defines normal weight individuals as having a BMI between 20 and 25. Overweight individuals have a BMI from 25 to 30, whereas obese people have a BMI higher than 30.

  4. From an evolutionary point of view, the body’s inclination to store fat promotes chances of survival in time of resource scarcity. Since resource scarcity has always been more common that resource excess, one might argue that the inability of storing fat should rather be considered defective, i.e. should be considered a disease. The species-typical distribution to define disease does not work either, since a certain degree of fatness appears to be approaching normality more than leanness, in some Western societies at least.

  5. Let it be clear that I do not deny the importance of appropriate medical care for those children that are morbidly obese and that suffer seriously from the consequences of their weight. However, there are only relatively few of those children, compared to the thousands of children included in the statistics that are not suffering from their condition.

  6. The expectation of treatment becomes explicit especially in for instance scientific papers on pharmacology, where researchers often conclude that whereas the effect of treatment is only limited, patients are nonetheless recommended to take drugs as part of a weight loss strategy. Even if a drug is moderately successful in invoking weight loss, the drug either does so only during a short period of time, after which it apparently becomes ineffective and weight is regained, or if the drug retains original efficacy, its effects are quickly reversed when the person stops taking it. Nevertheless, researchers and practitioners alike continue to recommend the prescription of these, sometimes toxic, drugs to the obese because even moderate or minor weight loss is considered recommendable over perpetuation of the obese condition.

  7. In the Netherlands for instance, overweight and obesity combined resulted in a prevalence figure of 16% in girls in 1997, of which 1.5% was accounted for by obese children. For a prevalence of 14% in boys, less than 1% was accounted for by obese children in the same year [24].

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Acknowledgements

The author wishes to thank the (members of the) BioTethics Consortium for their invitation to participate in workshops that led to the preparation of this paper, and for comments received on draft versions of this article. She also wishes to thank two anonymous reviewers and Annika Zorn and Paolo Merante for their comments and other input. The author receives financial support from the Dutch government and the European University Institute in Florence, Italy. Any mistakes made are for the sole responsibility of the author.

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Correspondence to Jantina de Vries.

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de Vries, J. The obesity epidemic: medical and ethical considerations. SCI ENG ETHICS 13, 55–67 (2007). https://doi.org/10.1007/s11948-007-9002-0

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