An ethical analysis of obesity, weight stigma, and public health

Abstract

Rates of obesity have increased significantly over the last thirty years in both adults and children, as have rates of associated chronic diseases such as type II diabetes mellitus and cardiovascular diseases. As scholarly and political attention turns to addressing the prevalence of obesity and associated diseases, it also turns to examining ethical issues, especially when seeking to justify different policies. Recent research has yielded much discussion of certain ethical issues such as responsibility, autonomy, paternalism, harm, and more specifically, the problem of weight stigma. An ethical issue not previously discussed is the government’s very identification of obesity as a public health concern. The governments of Western democratic countries such as Australia and the United States of America continually identify obesity as a public health concern in press releases and policies. In this thesis, I argue that this identification constitutes an action that itself requires ethical justification. I propose several criteria that ought to be met to provide ethical justification whenever the government identifies a public health concern, and I focus on obesity as a case study. I conclude that the government was not ethically justified in identifying obesity as a public health problem. This is largely because evidence suggests that there is very little that can be done to effectively reduce obesity rates, and because of the creation and perpetuation of harm that resulted from this identification, particularly relating to weight stigma. Obesity is deeply stigmatised and, as noted by many authors, weight stigma has the capacity to negatively impact physical and mental health, to perpetuate obesity, and to worsen social harms (e.g. increasing social isolation and discrimination). In turn, this negatively affects areas of a person’s life such as self-esteem, academic achievement, employment opportunities, income, and health. Given this, it is of great importance that the stigmatisation of obesity and weight be considered seriously. Within the academic literature that theorises about weight stigma and studies its impact, there are a range of approaches regarding how weight stigma ought to be dealt with. Although there is a growing voice in the literature calling for interventions to reduce weight stigma, the few reported interventions have been largely unsuccessful. In this thesis, I develop a spectrum to categorise these approaches, identifying and discussing nuanced variances between each position along the spectrum. I demonstrate that weight stigma ought to be combatted directly, and provide suggestions for weight stigma-reducing interventions. Finally, I develop a matrix that may be useful in targeting the mechanisms by which weight stigma is understood to operate.