Written By Johanna Ahola-Launonen
University of Helsinki
Chronic diseases, their origins, and issues of responsibility are a prevalent topic in current health care ethics and public discussion; and obesity is among one of the most discussed themes. Usually the public discussion has a tendency to assume that when information about health lifestyle choices exist, the individual should be able to make those choices. However, studies increasingly pay attention to the concept of food environment[1] and its huge influence. If obesity really is that serious an issue to public health, health care costs, and economy as many suggest, focus should be directed to the alteration of food environment instead of having the individual as the primary target of intervention.
Traditionally, the main target of intervention in prevention measures for obesity have been, in all countries, directed to the individual[2]. Public health professionals give information about healthy food, citizens are encouraged to change their lifestyle, and the media is full of advice for losing weight. However, the measures directed to individuals have had little effectivity. In some countries, the “pandemic of obesity” have stopped, but nowhere has there been a clear decrease in obesity levels.
Studies suggest that changes in the food environment explain most of the population’s obesity. The food environment has undergone a considerable change over the past 30 to 40 years when consumption has become easier along increasing availability, variation and low costs. High-energy density food tends to be among the cheapest alternatives, and large packages decrease the unit price. Eating has become extremely easy; snacks are sold almost everywhere, microwave meals are fast, and restaurants are on every corner. The larger the portion sizes and packages, and the bigger the variety, the more people consume. Even if the “sitting lifestyle” would be a partly explanation, the increase in energy intake is the most relevant factor[3] to explain the obesity levels.
Researchers[4] have also paid attention to how much people can reasonably control their eating in a genuinely conscious manner. The process of eating contains a lot of routine-like automatizations – if all the choices[5] and decisions related to eating were always conscious, it would be a great burden to cognitive capacities. A key in the ability to be creative and efficient is that we automatize daily routines. Due to this automatization, external cues and the plenty impulses in the food environment easily affect our eating habits.
Thus, the studies suggest[6] that the fact that the population gains weight is not due to a reduced self-discipline or will-power. It is a result of people responding normally to the obesogenic environments they find themselves in. Surely, there is no reason to take this in a deterministic way – the possibilities that individuals have to resist the impulses of the food environment are different. The reasons for these differences include various reasons related to time and money available for eating, learned habits, epigenetics, and many more.
However, the main conclusion from these studies is that the effective target of intervention, if obesity is wanted to be reduced at the population level, is the food environment, not the individual. Societies can affect to the food environment by pricing policy and other regulations. Systematic reviews show[7] that increasing prices with taxation decreases the consumption of the product in question. The primary measures should be directed to decreasing the consumption of high-energy density foods and sugar sweetened beverages, and find solutions to returning the sizes of portions and packages to normal.
At this point questions usually arise about the limits of restricting the food industry. We can imagine many good analogies to show that it is not the industry’s responsibility if people use their product in a wrong or unhealthy manner. Still, if the case of obesity is that grave as the health officials suggest, this is worth consideration. What is the point of having group A using millions to increase the consumption of high-energy density foods (or large portion sizes, big packages, etc), and then having group B using millions to try to educate people not to consume these foods and repair damage brought by over-consumption of these foods?
If obesity is that big of an issue, and the food environment has the greatest influence to food consumption, why do we still speak about the individual?
[1] http://www.hsph.harvard.edu/obesity-prevention-source/obesity-prevention/food-environment/
[2] http://www.ncbi.nlm.nih.gov/pubmed/15614941
[3] http://www.ncbi.nlm.nih.gov/pubmed/19828708
[4] http://www.cdc.gov/pcd/issues/2008/jan/07_0046.htm
[5] http://digest.bps.org.uk/2007/01/mindless-eating-food-decisions-we-dont.html
[6] http://www.ncbi.nlm.nih.gov/pubmed/21872749
[7] http://www.ncbi.nlm.nih.gov/pubmed/25703109
Why do we speak about the individual? We speak about the individual because that is a political choice, and not a matter for science. Politics drives policy, and politics is not about facts. In this specific case there are social conservatives who see this as an individual responsibility issue, and those who see fat people as oppressed individuals. That last group includes some feminists.
It is interesting to compare views on this issue to attitudes to homophobia: see the recent post on ‘The Virtuous Homophobe’. In the case of homophobia, the academic and policy community is unwilling to accept that it might have a biological origin. They prefer to treat it as an undesirable value preference originating in ignorance, and/or as a remnant of historical prejudice. They tend to assume that a process of emancipation will alter attitudes, and that homophobia will soon disappear. In other words, they see homophobia as ‘cultural’ in the broad sense, meaning non-biological. I think homophobia is a biological fact, but I am well aware that is an unpopular minority opinion.
Now in the case of obesity, the positions are to some extent reversed. It is the academic and policy community, who prefer to excuse the obese individuals. The consensus is that there is ‘something wrong with their brain’ – that they are victims of an inner compulsion. That is usually combined with shifting the blame to others, primarily the food industry. That’s what Johanna Ahola-Launonen does here: she claims that the food industry has created an “obesogenic environment”, which individuals can not resist, or not fully resist.
The social conservatives, on the other hand, see this precisely as ‘cultural’ in the broad sense, meaning non-biological and non-medical. Even if there is a fast-food outlet on every street, nobody is forced to eat there, and cheap healthy food is available to all, if you put some effort into looking for it. The obese are simply bad people, who reflect a general culture of laziness and dependency. They should show some discipline, go on a diet, take up sport, get off welfare benefits, get a job, save some money, get a better education, get a better job, and so on.
The ‘pro-fat movement’ is partly a response to this, although identity politics tends to generate new emancipatory movements anyway. Their position is very similar to the emancipatory claims of gays: accept us as we are, and ban all discrimination. Society must make provision for obese people, at no extra cost to the obese themselves. In their view, the social conservatives are the bad people: they are bigots, comparable to homophobes and racists.
So ethical judgement on the obesity issue needs to take account of the political context, and obviously so does government policy. From ethics, I also expect some consistency. What is in any case clear, is that there is no general public consensus on this issue, and given the divergent value orientations, it is pointless to look for one. The state can clearly ban all unhealthy food, if it has the authority and credibility to do so. In western democracies, however, there will be insufficient political consensus for such draconian policies.
Thanks for the thorough and excellent comment! I totally agree that the case in question includes loads of politics – leaving that aside is mostly my rhetorical choice. This is because when the individual-centered means to tackle obesity are discussed, the politics are neither mentioned there. Encouracing the individual to do this-and-this are mainly justified with scientific terms, demonstrating how much this-and-that lifestyle change could alter this-and-that health levels. So, the question I want to make is this: IF the premises of the discussion are found from effectivity, result, and science, why do we THEN speak about the individual?
If the case is political, the discussion should be political: What is the aim in the discussion? Is it reducing obesity levels, or is it that some social conservative (or other) wing wants to get to state the “right way of living”? What way of living? Based on what argument? Oh, scientific? I give the original post. Oh, political? Why should that wing get to define the proper way? Why is that way of living the proper way of living? What is the discussion really about?
You have touched on important issues that give a valuable insight.
Lack of choice is disagreeable. Forced choices can cause rebellion. We have the right as “free” people to make bad choices. But I don’t believe people are intentionally self destructive. Genetics and environment are huge influences on food choices. When preferences are genetic and the conditions that led to the genetics are very different, the results can be tragic. Humans are social and strongly influenced to conform to the people surrounding them. They need clear and powerful guidance to make alternate choices. The guidance to the public is muddy and fragmented with very mixed messages. When confusion reigns, convenience, conformity, consistency are the rules. The political question is whose needs do we address, clarity for healthy choices of our populations based on scientific truths or a Darwinian process that protects business and status quo?
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