Obesity and Responsibility

Abstract

Obesity is defined by theWHO as “abnormal or excessive fat accumulation that may impair health.” It is a step beyond overweight, although the two are often addressed together: In practice, overweight and obesity are often defined by reference to bodymass index (BMI), which is the weight of a person in kilograms, divided by the square of their height in meters. A BMI of over 25 is considered overweight, while a BMI over 30 is obese. As a measure of obesity, however, BMI has its critics, for reasons such as the fact that it does not distinguish between lean mass and fat mass and that it may not accurately account for the relevance of height differences. The WHO estimates that obesity has nearly doubled worldwide since 1980; in 2008, 35 % of adults were estimated to be overweight and 11 % were obese. This problem has been particularly acute in the Western world: In the United States, over one third of adults are obese, while across the European Union, the figure varies between less than one tenth and almost a quarter. Childhood obesity rates are equally worrying: In Europe, approximately one fifth of children and adolescents are overweight; one third of these are obese. In the United States, roughly 17 % of children and adolescents are obese. Obesity is regarded as both an individual and social problem because it is associated with a number of health risks, such as diabetes, high blood pressure, heart disease, and some cancers. It gives rise to a number of ethical issues including responsibility for food choices, the role of the food industry, and public health advice. Obesity in children adds an extra dimension to the ethical issues. These include advertising to children but also intergenerational justice, in so far as concerns have been expressed that life expectancy may decline as a result of changes in the incidence of obesity. In relation to this group, however, it is arguably the case, more so than with other social groups, that the class of people buying and preparing food is not identical with those consuming it, making the identification of responsibilities, especially parental responsibilities, more complicated. The range of courses of action available to counter obesity gives rise to ethical issues specific to each one: from attempts to “nudge” people into making particular choices, regulation of advertising, the role of the diet industry, functional foods, to gastric surgery as arguably the most extreme intervention. Celebrities increasingly are drawn upon to endorse particular courses of action, as in other sectors of the market. In addition to specific issues, however, some of which raise concerns about the extent of coercion involved, there are generic ones concerning stigmatization and discrimination.