Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of (...) obesity than does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one. (shrink)

Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to internal processes, obesity is not a disease. (...) Obesity undoubtedly can result in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a “social disease” may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals’ interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese. (shrink)

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. (shrink)

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. (shrink)

In this paper, we aim at rethinking the concept of obesity in a way that better captures the connection between underlying medical aspects, on the one hand, and an individual’s developmental history, on the other. Our proposal rests on the idea that obesity is not to be understood as a phenotypic trait or character; rather, obesity represents one of the many possible states of a more complex phenotypic trait that we call ‘energy metabolism.’ We argue that this (...) apparently simple conceptual shift can help solve important theoretical misconceptions regarding the genetics, epigenetics, and development of obesity. In addition, we show that our proposal can be fruitfully paired with the concept of developmental channeling of a trait, which connects to the study of the plasticity and canalization of complex traits. Finally, we discuss the potential impact of our approach on the assessment, treatment, and social narratives of obesity. (shrink)

Is there an obesity crisis? Postmodernists like Michael Gard argue that there is not while epidemiologists argue that there is and it is growing. In this paper, I argue that such polarized positions are not a sign of healthy dialectic, but a sign of an increasingly fragmented and reductionist obesity research field. As a further example, I draw on long term seemingly unresolvable disputes within nutrition brought about through reductionist approaches. I argue that there is an obesity (...) crisis, that it is linked to other major global crises and that to meaningfully address it will require greater unity within the obesity research field. I therefore put forward the post-reductionist general concept of semiotic corruption developed by process philosopher, Arran Gare and drawn from the emerging post-reductionist field of biosemiotics, as a potential unifying concept for the field. In doing this I explore the history and nature of biosemiotics and its links to other holistic traditions which all seek to mend the gross philosophical errors committed by those such as Descartes who ruptured the relationship between living and non-living processes. I then discuss some implications of this holistic approach for better understanding obesity as semiotic corruption, particularly focusing on the concepts of embodied, anticipatory systems and the need for a new ethics of health which understands and augments the real complexity and irreducibility of life. (shrink)

Obesity is one of the most significant public health challenges and becomes a public health problem. Consumption of fast-food, which have high energy densities and glycemic loads, and expose customers to excessive portion size, is frequently associated with weight gain, therefore, it is hypothesized that relative availability of fast-food is a risk for obesity.

Childhood obesity has become a central concern in many countries and a range of policies have been implemented or proposed to address it. This co-authored book is the first to focus on the ethical and policy questions raised by childhood obesity and its prevention. -/- Throughout the book, the authors emphasize that childhood obesity is a multi-faceted phenomenon, and just one of many issues that parents, schools and societies face. They argue that it is important to acknowledge (...) the resulting complexities and not to think in terms "single-issue" policies. -/- After first reviewing some of the factual uncertainties about childhood obesity, the authors explore central ethical questions. What priority should be given to preventing obesity? To what extent are parents responsible? How should we think about questions of stigma and inequality? In the second part of the book, the authors consider key policy issues, including the concept of the 'obesogenic environment,' debates about taxation and marketing, and the role that schools can play in obesity prevention. -/- The authors argue that political debate is needed to decide the importance given to childhood obesity and how to divide responsibilities for action. These debates have no simple answers. Nonetheless, the authors argue that there are reasons for hope. There are a wide range of opportunities for action. Many of these options also promise wider social benefits. (shrink)

The belief that obese people ought to lose weight and keep it off is widespread, and has a profound negative impact on the lives of the obese. I argue in this paper that most obese people have no such obligation, even if obesity is bad, and caused by calorie input exceeding output. Obese people do not have an obligation to achieve long-term weight loss if this is impossible for them, is worse than the alternative, or requires such an enormous (...) effort in relation to what stands to be gained that this option is supererogatory rather than obligatory. It is highly plausible that most obese people fall into one of these three groups. Politicians may still have obligations to fight obesity, but they ought to do so through progressive politics rather than blaming and shaming. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? (...) Suppose we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

Partly in response to rising rates of obesity, many governments have published healthy eating advice. Focusing on health advice related to the consumption of animal products (APs), I argue that the individualistic paradigm that prevails must be replaced by a radically new approach that emphasizes the duty of all human beings to restrict their negative “Global Health Impacts” (GHIs). If they take human rights seriously, many governments from nations with relatively large negative GHIs—including the Australian example provided here—must develop (...) strategies to reduce their citizens’ negative GHIs. As the negative GHIs associated with the consumption of many APs are excessive, it is my view that many governments ought to adopt a qualified ban on the consumption of APs. (shrink)

This article draws on scientific explanations of obesity to motivate the creation of a system of paternalistic public health interventions into the obesity epidemic. Libertarian paternalists argue that paternalism is warranted in light of the cognitive limits of human decision-making abilities. There are further, specific biological limits on our capacity to choose and maintain a healthy diet. These biological facts strengthen the general motivation for libertarian paternalism. As a consequence, the creation of a system of paternalistic public health (...) interventions into the obesity epidemic is warranted. (shrink)

Obesity is a public health problem influenced by behavioral patterns that span an ecological spectrum of individual-level factors, social network factors and environmental factors. Both individual and environmental approaches necessarily include significant influences from social networks, but how and under what conditions social networks influence behavior change is often not clearly mapped out either in the obesity literature or in many intervention designs. In this paper, we provide an analysis of recent empirical work in obesity research that (...) explicates social network influences on eating behaviors. We argue that a relational rather than individualistic view of personhood should help us better understand the content and context of social network relations that inform health behavior choices. We introduce the concept of ‘identity-constitutive affiliations’ as the glue that binds these social relationships together. Finally, we outline the implications for public health ethics in the development of effective interventions to address overweight and obesity, leveraging the content and context of social network ties to reinforce healthy (or alter unhealthy) eating. More complex treatment of positive and negative behaviors stemming from social network connections should lead to more comprehensive theoretical models of health behavior change and more effective public health interventions. (shrink)

Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual’s control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals’ personal control, there are a range of (...) biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm. (shrink)

Human enhancement is the term used for applications of biomedical knowledge that aim to improve human form or functioning beyond what is necessary to restore or sustain good health. Genomics is one of the research-areas that promises to offer such possibilities in the near future, and body weight – especially over-weight and obesity - is one of the human characteristics at which these will be directed. This paper offers an overview of some of the moral issues that the subject (...) of enhancement raises when related to obesity and genomics. After a brief discussion of the different perspectives on obesity and on the meaning of the term enhancement, a framework is presented in which the moral issues at stake are organised according to perspective on obesity and moral outlook . An inventory is made of the different ethical discussions that possible future genomics-based options for the prevention or treatment of obesity and overweight may evoke. These include justice, obligations with regard to life-style, the limits of medical practice and the value of food and food-cultures. Finally, some speculations are made with regard to future possibilities for genetic modification and “self-evolution”. (shrink)

Since overweight and obesity have been framed as one of the main contemporary health challenges in industrialized countries, it has become a matter of public health efforts. While the belief that obese individuals are personally responsible for their body weight prevails in public opinion, evidence-based health science widely acknowledges that obesity is significantly influenced by socio-economic factors and thus that prevention requires structural changes. This constellation bears the chance of politicizing an issue formerly conceived of as private which (...) really is dependent on societal contingencies, such as the particular availability of food. Reflecting on the prevention of obesity from an ethical point of view, therefore, requires an elaborate concept of political responsibility. The core thesis of this paper is that existing approaches within the field of obesity ethics fall short in reasonably grasping the political dimensions at play, due to the prevailing individualistic understanding of responsibility. Drawing upon Iris Marion Young’s concept of political responsibility, I propose an alternative approach that emphasizes the structural determinants of obesity. By arguing this way, obesity prevention comes into view as a public endeavor that involves public discourse as well as shared action. Political responsibility then cannot be discharged merely by intrusive governmental action nor by individuals on their own, but should be considered as a task all of us share. As I will sketch in the last part of the paper, this includes contesting discourses on interpretations of need. Thereby, the paper contributes to recognizing obesity as a social instead of an individual problem. (shrink)

It is staggering to observe the new normal in America: 37.9 percent of adults are obese, and 70.7 percent are either obese or overweight. One out of every five minors is obese. The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex, but if we drill down, sugar is a deeply consequential pathway to (...) class='Hi'>obesity, and the single greatest dietary source is sugar-sweetened beverages. The copious amount of sugar in the American diet is no accident. Industry practices and regulatory failures have fueled this explosion. Yet there are sensible, effective interventions that would create the conditions for healthier behaviors. What are the key interventions, and how can we overcome the social, political, and constitutional roadblocks? Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high-risk settings such as schools and hospitals. Each intervention deserves detailed analysis, but I'm kick-starting scholarly and policy conversation by systematically laying out the major legal tools. (shrink)

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 post-menopausal (...) women newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

It is no secret that one of the biggest public health challenges facing this nation is the obesity epidemic. Two-thirds of adults and one-third of children and teens are either obese or overweight. For adults, the number of obese has doubled since 1980, and for children age 6-11 the number of obese has quadrupled. The epidemic has changed what we thought we knew about medicine. For example, until fairly recently, type 2 diabetes was known as “adult-onset” diabetes. But doctors (...) have dropped this moniker as youth account for almost half of new type 2 diabetes in certain communities. Further, there has always been an assumption that life spans and health would improve with advancements in medicine and technology. However, obesity is related to over 20 major chronic diseases, and therefore obese children are more than twice as likely to die before the age of 55 compared to healthy-weight children. In other words, if trends are not reversed, America’s current generation of children are likely to have shorter life spans than their parents. (shrink)

This article explores the enterprising act of socially constructing fatness, or overweight and obesity, as an individual and collective problem. We argue that this process is complex and hence draw liberally on and extend an eclectic range of scholarship when presenting a typology of obesity epidemic entrepreneurs, that is, those who actively make fatness into a correctable health problem. Using a variety of data, we consider six main ideal typical entrepreneurs: creators, amplifiers/moralizers, legitimators, supporters, enforcers/administrators and the entrepreneurial (...) self. We conclude with a critique of obesity epidemic entrepreneurship and underscore the broader salience of our work for the sociology of the body/embodiment. The relevance of social studies of the body for the obesity debate and critical weight studies is also highlighted. (shrink)

Ghosn, Mariam The causes of obesity are complex. Both our attitudes and lifestyles will need to change in order to successfully address this issue.

This article focuses on how an often-overlooked portion of PPACA, “Community Transformation Grants,” might close the evidence gap in the relationship between obesity and the built environment and provide a pathway to effectively address this medically and economically costly epidemic.

Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide coverage for preventive-health services, which include obesity screening and nutritional counseling. In addition, employers will soon be able to offer premium discounts to workers who participate in wellness (...) programs that emphasize behavioral choices. These policies presume that government intervention to reduce obesity is necessary and justified. Some people, however, argue that individuals have a compelling interest to pursue their own health and happiness as they see fit, and therefore any government intervention in these areas is an unwarranted intrusion into privacy and one's freedom to eat, drink, and exercise as much or as little as one wants. This paper clarifies the overlapping individual, employer, and social interest in each person's health generally to avoid obesity and its myriad costs in particular. The paper also explores recent evidence on the impact of government interventions on obesity through case studies on food labeling and employer-based anti-obesity interventions. Our analysis suggests a positive role for government intervention to reduce and prevent obesity. At the same time, we discuss criteria that can be used to draw lines between government, employer, and individual responsibility for health, and to derive principles that should guide and limit government interventions on obesity as health reform's various elements (e.g., exchanges, insurance market reforms) are implemented in the coming years. (shrink)

The obesity epidemic is not only impairing the health of millions of Americans but also giving rise to billions of added dollars in health care spending. Climbing rates of obesity over the past decades are one of the predominant determinants behind the surging progression of health care expenses in the United States. Moreover, the less fit and less productive U.S. workforce has gradually eroded the nation’s industrial competitiveness. Since the early 1970s, adult obesity rates have doubled and (...) childhood obesity rates have more than tripled, while health expenditures have risen two percentage points faster than the Gross Domestic Product, burgeoning from 8.8 percent in 1980 to a projected 17.9 percent in 2011. Studies analyze that greater than a quarter of America’s health care expenses are attributed to obesity. The stunning growth in obesity has been imputed for 20 to 30 percent of the increase in health care costs since the late 1970s. If the proportion of obese population had stayed unchanged, then health care expenditures in America would be approximately 10 percent less on a per capita average than they are today. (shrink)

With an estimated 12.1% of children aged 2–5 years already obese, prevention efforts must target our youngest children. One of the best places to reach young children for such efforts is the early care and education setting. More than 11 million U.S. children spend an average of 30 hours per week in ECE facilities. Increased attention at the national, state, and community level on the ECE setting for early obesity prevention efforts has sparked a range of innovative efforts. To (...) assist these efforts, CDC developed a technical assistance and training framework – the Spectrum of Opportunities for Obesity Prevention in the ECE setting – which also served as the organizing framework for the Weight of the Nation ECE track. Participants highlighted their efforts at national, state, and local levels pursuing opportunities on the Spectrum, the standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. Strong leadership and collaboration among a broad group of stakeholders; systematic assessment of needs, opportunities and resources; funding sources; and training and professional development were reported to be integral for successful implementation of standards and best practices, and sustainability. (shrink)

Obesity is defined and identified in a number of ways, depending on whether it is in a medical, social, public health, or other context. After a brief primer on obesity, its causes and effects (and in particular its gender-based effects), this entry will examine weight stigmatization in more detail, giving an overview of some of the major results of studies across social science and public health fields. Next will be a discussion of two main approaches from which to (...) understand and address effects of weight stigmatization. Two common approaches – those pursued by public health ethicists and by various feminist scholars – overlap in some ways but differ substantively about the nature and medical status of obesity. Finally, this entry summarizes responses to issues of obesity and gender from the standpoints of both ethical approaches. There is a growing consensus across disparate groups about how to understand obesity as a social phenomenon, how to address it, and even how to reconceive health and fitness in ways that underplay the importance of body weight. (shrink)

This article explores how the notion of obesity as health problem (1) functions to obscure or justify global inequities related to food production and access and (2) indicates still deeper problems of injustice and the neglected role of embodiment in analyses of justice and injustice, and notions of political subjecthood. Food, the need to eat, and the food system shape social existence profoundly yet are underexplored in philosophy, especially political philosophy. Drawing on disability theory and food studies, this article (...) uses the crisis of body weight to explore relationships between neoliberalism, transnational capitalism, the industrialized agro-food system, and world health. Obesity discourse spotlights lifestyle choices of individuals, casting women especially as making irresponsible decisions for their families. A politically informed (and more medically sophisticated) perspective suggests that the real crisis is a social pact, which I term the ThinContract, predicating personhood and full social inclusion on body type. (shrink)

In recent years policy makers and public health professionals have described obesity and its associated diseases as a major global public health problem. Bioethicists have tried to address the normative implications of proposed public health interventions by developing guidelines or proposing ethical principles that ethically grounded health policy responses should take into consideration. We are reviewing here relevant literature and conclude that while there are clearly health implications resulting from the increasing number of seriously obese people across the globe, (...) there appear to be legitimate questions about the scope of the problem as well as questions about whether particular demonstrable correlations are indicative of causations. These empirical questions require further clinical and epidemiological research. We then review currently discussed public health ethics guidance documents and proposals. Suffering from the same conceptual problems that are known features of principle-based bioethics, insofar as their capacity to ground ethically justifiable policies is concerned, they are unsuitable for actual policy development. Even if the empirical questions were resolved, health policy makers could not rely on currently existing prominent public health ethics guidance documents to develop ethically defensible policies. Further empirical and ethics research is necessary to develop ethically defensible public health policies targeting obesity. (shrink)

This paper considers the role of physicaleducation researchers within current publicconcerns about body shape and weight. UsingUlrich Beck's notion of `risk' it examines howcertainty about children, obesity, exercise andhealth is produced in the contexts of `expert'knowledge and recontextualised in the academicand professional physical education literature.It is argued that the unquestioning acceptanceof the obesity discourses in physical educationhelps to construct anxieties about the body,which are detrimental to students and silencesalternative ways of thinking and doing physicaleducation.

Stewart and Korol contend that obesity is benign. In support of their position they have focussed on selected papers that do not take into consideration key realities. Their attempt to minimise the impact of obesity appears to centre on how difficult it can be to lose weight by diet alone and problems with measurements of obesity, while failing to acknowledge the specific and well-documented impact of deleterious biochemical alterations arising from central obesity. Stewart and Korol also (...) do not point out the considerable controversy with the fat but fit concept. Whether looping from above or below, nothing changes the biochemical realities of central obesity. Above all, Stewart and Korol never once mention the benefits of obesity prevention, rather focussing on the difficulties of losing weight. Thus, respectfully, a word of caution is put forward on the views of Stewart and Korol regarding obesity. (shrink)

This study draws the attention towards the importance of reducing weight discrimination against children for their educational success, as an issue of social justice. We investigate the consequences of early-onset obesity identifying the mediating mechanisms in the relationship between childhood obesity and academic achievement. To do so, we employ the Early Childhood Longitudinal Study-Kindergarten Cohort in the US and apply a parallel process latent growth model with a combination of quasi-experiments and econometrics. The results of this study suggest (...) that teachers may serve as a significant source of weight bias, especially for girls. (shrink)