Complex obesity debate

A report by Vikki Entwistle, Associate Director, SDHI.

On Friday 18th May we were delighted to welcome a diverse audience that included public health leads and practitioners from NHS Tayside and NHS Fife as well as academic colleagues from a range of disciplines from the Universities of St Andrews and Dundee to a seminar given by Dr Stacy Carter from the Centre for Values, Ethics and the Law in Medicine at the University of Sydney.
Stacy took us through a carefully constructed and well illustrated argument against presenting public health activity as activity against obesity. She started by stressing that body weight is related to health, but in a complex variety of ways, so weight loss contributes significantly to health gain in some people (e.g. those who have diabetes or pre-diabetes) but not all people, and efforts to lose weight can be harmful in various respects. Thus while support for weight loss can be a very appropriate and important goal in the clinical care of some individuals, it is potentially problematic as a public health goal.

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Stacy argued that at a population level, talking about obesity as a target problem to be addressed is just one way of ‘framing’ (or looking at) a cluster of important contemporary health and social problems. As some collective (public) actions that aim to improve population health or the broader wellbeing of communities already illustrate, we can identify factors that tend to contribute to poor health and wellbeing in a range of sectors (transport, food policy, industry regulation, housing, social development etc.). Stacy’s key point was that not only was it important to support collective action to tackle all of these, it would be more ethical to present the target of such action not just or primarily as obesity but rather as the social causes of poor health. She explained that that the obesity frame reinforces the negative labelling and stigmatisation of people who are obese, and directs attention to the ‘canary in the coal mine’ rather than the ‘gas leak’ of conditions producing poor health that should be the primary concern. An alternative framing of the problem that focused more explicitly (in words as well as in action) on the social contributors to poor health, would raise fewer ethical problems.

Stacy’s presentation stimulated a wide-ranging and vigorous debate that highlighted the contestability of some key public health concerns and approaches. For me, this confirmed a need to consider the ethical as well as the empirical aspects of public health, and to promote robust conversations between policy leaders, practitioners and researchers about both.

The slides from this presentation will follow shortly.

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