Governing Obesity

Governing Obesity (GO) was set up to provide novel means for governing obesity and its consequences via effective interventions at the societal and individual level, from an early stage towards the morbidly obese individuals, while avoiding unintended and negative effects.

Project GO was one of 18 research initiatives established in 2013 as part of the University of Copenhagen Excellence Programme for Interdisciplinary Research (2016). The initiative ended by the end of 2017.

Research

A core assumption behind GO is that obesity is not one problem, but rather should be viewed as a complex challenge, which must be addressed differently depending on age, stage of obesity and severity of medical co-morbidities. This assumption is applied in GO by organizing the research in five interconnected work packages, each involving scientists from several faculties and scientific disciplines.

 

 

 

 

 

 

 

 

 

 

Work package 1: Assigning responsibility for governing obesity: political or individual? Actions, strategies and dilemmas in obesity interventions

This work package addressed the issue of responsibility for obesity ranging from the political to the individual level with specific focused on the ethical and other dilemmas to which obesity interventions give rise. It combined ethics and philosophy, law, history, policy analysis and epidemiology.

Aims

We wanted to investigate when and how public intervention is required and seen as legitimate from the perspectives of rights to health, privacy, non-discrimination, justice and beneficence. The project examined how actors frame and react towards obesity, assessed health-related and social consequences of these responses individually and societally, and outlined possibilities for new models to address the many challenges concerning governing obesity. The overall aim, then, was to rethink a series of questions concerning individual and societal responsibility.

Visions for societal impact

  • To provide inspiration and ‘food for thought’ for politicians and others deciding about obesity policies.
  • To point to new interventions that may reduce obesity problems and avoid some of the adversities of existing policies such as stigmatization and victim blaming.

Methods

We used an interdisciplinary approach comprising philosophical/ethical, legal, political and epidemiological perspectives on obesity.

Philosophy/ethics: an ethically defensible role for personal responsibility for one’s own weight.

This study proceeded to investigate how and to which extent “personal responsibility” for obesity can play an effective and justifiable positive role (Matravers et al., 2007, Wikler, 2012). Both legal, material and social studies will figure prominently as background here. The goal was to provide ethical input to new “models of responsibility”, which avoid two of the major pitfalls of the current discourses, i.e., seeing the agent as a puppet of structural determinants, and with no agency at all; or seeing the agent as fully accountable and responsible for obesity (Matravers et al., 2007, Segall 2010, Nielsen, 2011). This raises or intensifies a string of moral challenges, among these freedom of conscience and lifestyle, the justifiable scope of state interventions, and respect for family autonomy (Ten Have et al., 2011). A better understanding of these issues will provide valuable input to the development of legitimate models for future policies.

Legislation: regulating obesity – responsibility and limits to public interventions.

We investigated how the responsibility for preventing and treating obesity is addressed in the legal framework (Garde, 2010). How much authority and autonomy is left to the citizens, and when are governments obliged to provide services or to intervene to ensure the citizens right to health (Hartlev, 2012)? When assessing whether a state intervention is necessary and proportionate, epidemiological evidence on health risk and effects of interventions and ethical reasoning are of importance (Bayer & Fairchild, 2004, Gruskin & Tarantola, 2005). This was investigated through an analysis of international and national legislation, case law and a comparative analysis of Denmark, Sweden and the UK. The project also included an analysis of stigma and the attitude to obese persons in various settings, as well as an assessment of how this complies with the principle of non-discrimination, which enjoys increasing attention in international legislation.

Policy analysis: the political problematization of obesity, responsibility and the role of science.

How obesity, and its causes, is defined as a political problem makes up a crucial aspect of political decisions or at least the legitimation of them. Depending on whether obesity is considered a result of individual choices, the activities of food industry and retailers, other societal factors or a biological "addiction", the responsibility will be placed differently and different governing technologies would be suggested. We examine the role of scientific, above all epidemiological, evidence in the policy process, and how science is co-produced by scientist and policymakers (Jasanoff, 2005). The other aim was to study to which extent stigma related to the state of obesity, and occurring as a result of preventive activities, is addressed by the politicians. Finally, we examined whether, and if so how, social inequalities in obesity are addressed in the policies (Vallgårda, 2011, Wright & Harwood, 2009). In these processes, emotional, moral as well as aesthetic aspects may play a central role (Saguy & Riley, 2005). Danish policy was compared to that of UK and Sweden.

Epidemiology: long-term health effects of changes in body weight and shape.

Epidemiological studies address long-term effects on morbidity and mortality of changes in bodyweight and -shape induced by various actions, including the types of interventions dealt with in workpackage 2,3 and 4. Determinants for beneficial and harmful effects are investigated and interpreted in the light of novel theories about the mechanisms of the harmful effects of obesity (Sørensen et al., 2010). Data was drawn from the Copenhagen City Heart Study, combining information from birth, childhood and through adulthood with repeated anthropometrics and register-based record linkages. Advanced statistical methods where used as appropriate for quantitative estimation of the associations as exemplified in more limited previous studies (Sørensen et al., 2005, Zimmermann et al., 2012, Zimmermann et al., Apr 2011,Zimmermann et al., Sep 2011). The project generated knowledge, which is of crucial importance in the analyses of responsibilities in governing obesity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

About project GO

The initiative was the next step in the establishment of truly integrated interdisciplinary obesity research at University of Copenhagen, harvesting the synergy at the interface between the disciplines and still exploiting the scientific excellence in each discipline.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact

Head of Governing Obesity
Bente Merete Stallknecht
Prorector, Professor

Phone +45 3532 7540

bstall@sund.ku.dk