The Obesity Pandemic-Whose Responsibility? No Blame, No Shame, Not More of the Same.

Abstract

No one doubts the economic costs of obesity, estimated at 5–14% of health expenditure for 2020–2050 (1), but there is disagreement whether fatness is considered a disease (2) or a behavioral risk factor, similar to smoking, alcohol and substance abuse that may lead to a disease (3). Current opinion also emphasizes social determinants and equity, thereby moving away from personal responsibility concepts (4). Although recent competencies for medical training do recommend chronic disease models and personalized obesity management care plans (5), there is no mention of topics such as self-management, locus of control or responsibility. It is not clear whether this is because they are considered unimportant or because they are not politically correct—yet, they are critical components for chronic disease management such as diabetes, post-transplant care and obesity (6). The paradigm chosen has major implications for prevention and treatment strategies. That the obesity pandemic continues unabated represents a catastrophic failure of government policy, public health, and medicine—but not only of these domains. Table 1 lists different levels of responsibility incorporating the sociotype ecological framework (6). Levels 1–4 represent context and systems; levels 5–7 society and interpersonal relationships; and levels 8–9 parental and intrapersonal health and psychological make-up. Personal editorial input from a leading obesity journal suggested that “at this point in time, … emphasis on the personal responsibility (rather than the biology), would only add to the stigmatization of obesity in general.” I disagree—and concerning the biology—see the beginning of the discussion section. Without considering aspects of responsibility, obesity management is severely compromised. There are at least two sides to personal responsibility: medicalizing obesity, which reduces it, and parental supervision, which emphasizes it, since fat children are at high risk for adult obesity (7). Finally, I suggest an integrated nine-level approach that eschews political correctness and hopefully is not more of the same. Table 1 The nine multilevel responsibilities and examples of strategies required for tackling obesity.