Sunday, February 3, 2008

The ethics of obesity prevention


Last Friday I participated in an expert meeting on ethical issues related to obesity prevention. Chaired by Professor Inez de Beaufort, professor in Medical Ethics, and together with different medical ethics researchers, representatives of health promotion organisations, a director of a health insurance company and colleagues in the field of behavioural nutrition and physical activity various dilemmas with ethical dimensions were discussed.

Inspired by 5 statements we discussed various ethical issues related to obesity prevention interventions.

A first issue is the lack of proven effectiveness of many obesity prevention interventions. Obesity treatments, i.e. weight loss interventions, have been shown to be largely ineffective and should therefore not be recommended. For obesity prevention, most intervention activities have not been evaluated, and it can be argued that it is unethical to ‘bother’ people with health promotion activities that may be ineffective or that may have negative side-effects. Nowadays medical new medical treatment can only be introduced if evidence-based. I can not understand why we do not demand the same from prevention interventions.

Another issue that was discussed was stigmatization. Obesity prevention interventions may lead to blaming overweight people, while experts nowadays generally agree that overweight an obesity are a normal reaction to an abnormal environment, and that weight gain and overweight are therefore only partly attributable to personal responsibility. My personal opinion is that obesity prevention should not be focussed on weight or weight loss, but on healthful eating and physical activity. Since maintaining weight loss is an illusion for the large majority of people who are overweight, we should focus on promoting healthy lifestyles. This will contribute to fitness despite fatness, and to probable prevention of further weight gain. This also means that we should be very careful to avoid stigmatization of overweight or obesity in our prevention interventions. In smoking cessation interventions we do not stigmatize lung cancer or COPD patients, but we have made smoking much less socially acceptable. A similar procedure could be considered regarding prevention of obesity: avoid stigmatization of people who are overweight, but make eating always and everywhere as well as complete lack of physical activity socially undesirable.

At the upcoming annual meeting of the International Society of Behavioral Nutrition and Physical Activity (http://www.isbnpa.org/) professor de Beaufort will give a keynote on the ethics of obesity prevention (see http://www.readeprojects.com/isbnpa/pg_ky.html) and one of the symposiums will be focussed on this topic too. Please also visit the website of a special European Commission-funded project on this topic: http://www.eurobese.com/

For an interesting report on ethical issues in public health from the Nuffield Council on Bioethics, please visit http://www.nuffieldbioethics.org/go/ourwork/publichealth/introduction .

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