Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 4
line between healthy and unhealthy food may be a
reason why food policy is not as restrictive as anti -
smoking policy.
A third reason for restricting the promotion of
some behavior more than others involves harm to
other people. Smokers and drunken persons pose a
threat to their environment. Consuming junk food
and soft drinks is not dangerous for others. I do not
get diabetes if my neighbor is a junk food addict. But,
so one could argue: there are other costs involved,
such as increased costs of the health care system. We
will not go into that argument here, 12,13 but do want
to mention that such harms are of a very different
nature, compared to direct threats to the health and
the safety of third parties.
The promotion of unhealthy products poses a specific
threat to children. Children are vulnerable to
influences from their environment. It is often more
difficult for them to separate fact from fiction in commercial
messages. They are not capable of making
autonomous choices about their lifestyle. They are, to
a great extent, dependent on their parents, who are
also misled by commercial information. The vulnerable
position of children provides a good reason for
restricting the marketing of products that are high in
saturated fat, sugar and salt, either directly targeted at
children or via their parents. This was recognized in
December 2007 when eleven major European food
and beverage companies announced a common commitment
to change the way they advertise to children.
They declared that they would neither advertise food
and beverage products in primary schools, nor to children
under the age of 12 (except for products that
fulfil specific nutrition criteria). 14
So far we have covered the background themes. In
the following sections we explore some ethical issues
that should be raised, analysed and thoroughly discussed
before implementing interventions to prevent
childhood obesity.
Evidence
The first issue concerns evidence and good reasons:
Do we have enough evidence or good reasons to
support the proposed program?
No conclusive evidence is available on the effectiveness
of most measures to promote healthy behavior,
but recent reports from (among others) WHO have
stated that the urgency of the problem makes waiting
for such evidence undesirable. 15 Although this strategy
is based on sound reasons, we should ensure that in
the process of implementing interventions we are not
over pressured by government, or panic, or by some
other pressure because something has to be done now.
The less clear the benefits of a campaign are, the
stronger the moral burdens weigh. This raises important
questions regarding effectiveness. Is a campaign
only effective if it creates weight loss? Or when it
creates awareness? Or should it make people feel
happier about their weight? How sure must we be
about the effectiveness of a measure before implementing
it? These are important issues to think about.
It is important to realize that an intervention always
creates costs, in financial terms but also in moral
terms, by intervening in lifestyle. The benefits have to
outweigh the burdens.
But in many cases we are not sure about the effectiveness
and this does not automatically mean that a
campaign should be stopped. In June 2007 government
funding for a Dutch clinic for obese children was
stopped because politicians claimed it was too costly
to proceed without evidence. But others argued that
as long as scientific evidence for long - term effects was
lacking, we should rely on experiences, which suggested
effectiveness. Accordingly, the project had to
continue precisely to gather scientific evidence. 16 More
generally, there is an obligation to rigorously evaluate
the effectiveness of interventions for which there is
currently little evidence, so that the evidence base can
be improved over time.
Stigmatization
The second issue is stigmatization:
Does the program or intervention target obesity as a
state of being or the underlying behavior? What are the
consequences in terms of possible stigmatization?
Targeting o besity and the
c reation of s tigma
Overweight and obese children face stigmatization
every single day of their lives. They are bullied, laughed
at, called names and associated with bad moral character
traits (being lazy, stupid etc.). In thinking about
interventions for treatment and prevention of obesity
it is important to note that they must necessarily differ
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