Assigning responsibility for governing obesity: political or individual? Actions, strategies and dilemmas in obesity interventions
This work package addresses the issue of responsibility for obesity ranging from the political to the individual level with specific focus on the ethical and other dilemmas to which obesity interventions give rise. It combines ethics and philosophy, law, history, policy analysis and epidemiology.
We want 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 examines how actors frame and react towards obesity, assess health-related and social consequences of these responses individually and societally, and outline possibilities for new models to address the many challenges concerning governing obesity. The overall aim, then, is to rethink a series of questions concerning individual and societal responsibility.
While acknowledging that many experts consider structural issues as the core of the “obesity challenge”, where social and environmental factors for which the individual is not responsible are seen as determining behaviours, a political, commercial and societal discourse of individualized responsibility is prevailing. Most lay people, and even the majority of health professionals, view obesity as a lack of individual self-control, rather than as a consequence of structural determinants (Lund et al., 2011); and this view is obviously influencing policy makers. To be able to govern obesity adequately, one needs to know more about how, and to which extent, obesity is caused by structures, for which political responsibility may be assumed, and by individual agency, which is possibly beyond the justifiable reach of political responsibility. For any assessment of obesity policies and interventions to make sense, knowledge about the overall effects of such interventions is essential. Hence, interdisciplinary research combing medical and epidemiological studies with philosophical, ethical, legal, and political studies is crucial. It is also important to be aware of problematic assumptions in the governing discourses of obesity interventions and policies. One such assumption is that preventing weight gain and losing weight are unequivocally good. However, while studies concur in showing beneficial effects of avoidance of excessive weight gain and short-term benefits of losing weight, they fail to show consistent positive long-term effect of weight loss when assessed on the basis of mortality (Sørensen et al., 2005, Harrington et al., 2009, Zimmermann et al., 2012).
We use 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 proceeds 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 is 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 investigate 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 is investigated through an analysis of international and national legislation, case law and a comparative analysis of Denmark, Sweden and the UK. The project will also include 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 is 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 examine 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 is 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 WP2, WP3 and WP4. 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 is 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 are 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 generates knowledge, which is of crucial importance in the analyses of responsibilities in governing obesity.
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.
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