Fighting Obesity: How Aggressive is Ethically Appropriate?

New Yorkers are well aware of Mayor Bloomberg’s attempts to fight obesity. Particularly memorable was the legislation that required chain restaurants to provide nutritional information for all menu items in the form of calorie counts. A low-fat berry coffee cake at Starbucks, something I considered to be a small snack, became much less appealing when I found out that “low-fat” still meant upwards of 300 calories! This type of legislation, along with legislation banning the use of trans-fats in restaurants, seemed reasonable to me. Though it is uncomfortable being forced to see the amount of calories in every snack, it is an effective way to make sure that people are conscious of their eating decisions.

Mayor Bloomberg’s more recent ban on the size of sugary beverages has been much more controversial. An argument from those who oppose the ban is that Bloomberg is creating a sort of paternalistic state and that it should be up to the people of New York to decide what size beverages they wish to have. Currently the ban still has not been passed in New York and continues to face considerable opposition. At one point, I might have whole-heartedly agreed with those in opposition. However, recently a family member faced some serious health complications that were exacerbated by being overweight. It is hard to see people we are close to overweight to the point of medical concern. Furthermore, while it is difficult enough keeping track of the foods we eat, it is nearly impossible to strictly monitor other people’s eating decisions. Being well educated and understanding the effects of obesity is often not enough to stop somebody from overeating or consuming unhealthy foods.

Situations like these could suggest that more aggressive approaches to fighting obesity are necessary. But how aggressive is ethically appropriate? We must take into account that overweight people already face a certain extent of “fat-shaming” and stigmatization. For example, airlines such as Samoa Air require that passengers pay fares based on how much they weigh. And there have been situations in which other airlines have required an overweight passenger to purchase an extra seat. It has already become part of our culture to react negatively to those who are overweight.
Nevertheless, some prominent scholars still assert that this is the best way to deal with the health problem. Recently, well known bioethicist Daniel Callahan published an article entitled “Obesity: Chasing an Elusive Epidemic”[1]In this article, Callahan brings attention to the fact that obesity is a social problem and in order to fight it he suggests that we as Americans must seriously restructure many facets of our lives. However, the suggestions that Callahan makes are centered around practices such as stigmatization and forms of social pressure. He asserts that we must ask uncomfortable questions such as:
 If you are overweight or obese, are you pleased with the way you look?
 Are you happy that your added weight has made many ordinary activities, such as walking up a long flight of stairs, harder?
 Would you prefer to lessen your risk of heart disease and diabetes?
 Are you aware that, once you gain a significant amount of weight, your chances of taking that weight back off and keeping it off are poor?
 Are you pleased when your obese children are called “fatty” or otherwise teased at school?
 Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?[2]

Callahan suggests that these questions must become part of our culture yet he does not take into account that to a certain extent they already are a part of our culture. And it is hard not to see some of these questions as offensive. They assume that people who are overweight only have themselves to blame. Furthermore, since “overweight” as a term is not specific, this type of social attitude can drive other unhealthy eating disorders such as anorexia which is also a prominent medical issue, especially for young women.

Mayor Bloomberg’s policies to fight obesity may seem paternalistic and at times arbitrary. However, perhaps his legislation, even if it doesn’t pass, serves as a way to make us think about what we eat and how much we eat without perpetuating stigmatization of those who are overweight. Campaigns to fight obesity that are centered on fat-shaming have already been proven ineffective, thus it is clear that a new approach must be devised[3]. In fighting obesity, initiatives must strike an ethical balance between paternalistic and overly critical policies, and ones that are just not strong enough to make a difference.

Hannah Kronenberg is an intern at the Montefiore-Einstein Center for Bioethics. She is a rising junior in the Woodrow Wilson School at Princeton University pursuing certificates in Values and the Public Life and Statistics and Machine Learning.

[1] Callahan, Daniel. “The Hastings Center – Obesity: Chasing an Elusive Epidemic.”The Hastings Center – Obesity: Chasing an Elusive Epidemic.
[2] ibid
[3] Puhl RM, Heuer CA. Obesity stigma: Important considerations for public health. Am J Public Health. 2010;100(6):1019–1028.

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