PoPulationand Public HealtH etHics

elatively limited, but one widely shared idea is that for surveillance to be
justified, surveillance data must actually be used in practice. 1 In what follows,
therefore, I will assume that those conducting the surveillance program will
decide (or have already decided) to take particular actions (e.g., to implement
screening and/or specific obesity reduction programs) if prevalence rates are
found to be sufficiently high (i.e., beyond some previously specified level).
Considering harms as well as benefits
The fact that a surveillance program might have benefits, however, does not
automatically mean that it should be implemented. We must also consider
the harms that might result from any surveillance program
and determine whether the benefits outweigh the
harms. As Dilworth et al. note, a possible harm regarding
the surveillance program under consideration is that
it could lead to stigmatization of children (and that this
may, in turn, pose risks to their health). Maintaining
confidentiality of surveillance results in the way they
describe would be feasible and would provide one way
of reducing stigmatization.
Another concern about stigmatization (which Dilworth et al. do not discuss)
is that the surveillance activity may focus children’s attention on obesity as
a “problem,” instigating (increased) teasing, etc., of obese children in schools.
The same thing could be said, however, about discussion of obesity as part of
health education in schools. The idea that no attention should be placed on
the problem of obesity in schools because this might focus children’s attention
on obesity as a “problem” and instigate teasing, etc., sounds implausible.
Nonetheless, this concern, given that it may arise even if surveillance data
remain confidential, should be addressed somehow. The surveillance activity,
for example, could be combined with an educational/socialization activity
specifically aimed at reducing stigmatization and bullying. Another option
would be to combine the surveillance with routine physical examinations
of children in schools, in which case it would not draw children’s attention
to obesity as a problem.
In any case, for the surveillance to be justified there would need to be reason
to expect that the health benefits of the surveillance would outweigh
Obesity Surveillance in School Children
27
Why should research
ethics requirements
regarding informed
consent and standards
of care not apply to
this case of obesity
surveillance ethics?