Synopsis
The rise in obesity in the worldwide population, particularly in children and young people, has clearly become a world-wide public health crisis (Lobstein, Baur, and Uauy, 2004). This crisis has spawned extensive attempts at legal responses to the issue in an effort to counter the rise in the numbers of overweight and obese citizens. Some of the legal initiatives and proposals have been initiated include taxes on certain foods and beverages, bans on certain sized food portions, limits to commercial advertising, bans on certain foods within schools, and even compulsory physical exercise for obese employees (ten Have, de Beaufort, Teixeria, Mackenbach, and van der Heide, 2011). As these laws and policies have become more and more extensive, there have been questions raised about the ethics of these kinds of initiatives.
Public health ethics is a relatively new area of medical ethics. This growing field will be challenged by the continued attempts to legislate behavior of the public in order to counter or at least slow the obesity crisis. The present research proposal is for an analysis of recent governmental attempts to control obesity using an ethical framework for analysis proposed specifically for the public health field. This aim of this ethical analysis will be to identify and characterize those aspects of the selected obesity prevention laws and policies both within Australia and outside Australia that trigger the ethical issues. This work will serve two purposes. First, this will provide a practical test for the proposed public health ethics analysis framework, and second, it will strive to provide concrete guidance for future initiatives in the obesity prevention area that will avoid, or at least reduce, the resulting ethical conflicts.
Literature Review
The literature review on this issue reveals a number of publications evolving their own particular framework for evaluating the ethical issues related to obesity prevention. Some of these publications include ten Have et al. (2012), Kersh, Stroup, and Taylor (2011), Meetoo (2010), and Kumanyika (2011). However, the Baum et al. framework (2007) has not yet been applied to obesity interventions, despite its development specifically for public health ethical issues. Additionally, Fry has proposed the bioethical analysis of the Australian obesity interventions using a stewardship model (2012), which can be used to compare and contrast to the general ethical analysis proposed for the present research.
Research Methodology
The proposed research will include an introductory overview of the complex issues implicated by obesity prevention measures (Thomas, Lewis, Hyde, Castle, and Komesaroff, 2010). It will include very high level discussion of the socioeconomic issues involved in obesity, the social bias against obese individuals, and the general need to balance public policy versus individual rights and responsibilities in any public policy intervention. The paper will then go on to utilize a particular ethical framework to examine a selection of obesity interventions for ethical issues.
Specially, Baum, Gollust, Goold, and Jacobson of the University of Michigan School of Public Health have formulated a framework of six considerations for the analysis of public health ethical issues (2007). The six considerations include: determining population level utility of the proposed action, demonstrating evidence of need and effectiveness of actions, establishing fairness of goals and proposed implementation strategies; ensuring accountability and accessing expected efficiencies and costs associated with the proposed action. The present proposal suggests examining a selection of recent legal attempts at controlling obesity within this framework and analyzing the ethical issues that result from an ethical review of obesity initiatives.
The precise obesity prevention interventions that will be analyzed are still being determined. Effort will be made to pick a variety of interventions to increase the range of issues discussed. Some possible interventions that could be analyzed include the New York City ban on super-size soft drinks, the promotion of bariatric surgery, community-based programs for increasing physical activity, menu calorie labeling in restaurants, national subsidizing of healthier alternatives such as fruits and vegetables, restricting/ banning sale of particular foods within schools, and mandatory physical exercise for obese employees.
After analysis of a selection of interventions, those with clear ethical issues will be discussed with a view toward changes to reduce the ethical problems. Those with possible ethical issues, perhaps only in selected applications, will be discussed with a view toward limiting those applications that have the ethical problems. Finally, those with few or no ethical issues will be examined for their characteristics that provide the better ethical position for the policies. The paper will conclude with lessons provided by the overview for policy-makers drafting new obesity combating initiatives in order to avoid potential ethical conflicts.
References
Baum, N. M., Gollust, S. E., Goold, S. D., and Jacobson, P. D. (2007). Looking ahead: addressing ethical challenges in public health practice. Journal of Law and Medical Ethics. 35, 4, 657-67.
Fry, C. L. (2012). Ethical issues in obesity interventions for populations. NSW Public Health Bulletin, 23, 5-6, 116-9.
Kersh, R., Stroup, D. F., Taylor, W. C., Childhood obesity: A framework for policy approaches and ethical considerations. Preventing Chronic Disease. 8, 5, A93. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181193/
Kumanyika, S. J. (2011). A question of competing rights, priorities, and principles: a postscript to the Robert Wood Johnson Foundation Symposium on the Ethics of Childhood Obesity Policy. Prevening Chronic Disease. 8, 5, A97.
Lobstein, T., Baur, L., and Uauy, R. (2004). Obesity in children and young people: a crisis in public health., Obesity Reviews. Suppl. 1, 4-85.
Meetoo D. (2010). The imperative of human obesity: an ethical reflection. British Journal of Nursing. 19, 563–8.
ten Have, M., de Beaufort, I. D., Teixeria, P. J., Mackenbach, J. P., and van der Heide, A. (2011). Ethics and prevention of overweight and obesity: an inventory. Obesity Reviews. 12, 9, 669-79.
Thomas S. L., Lewis S., Hyde J., Castle D., and Komesaroff P. (2010) The solution needs to be complex: Obese adults' attitudes about the effectiveness of individual and population based interventions for obesity. Biomedical Central Public Health, 10: 420.
