Preventing Childhood Obesity - Evidence Policy and Practice.pdf

No country for fat children? Ethical questions concerning community-based programs to prevent obesity
from interventions aimed at reducing tobacco use or
excessive consumption of alcohol. Obesity is a state,
not a behavior, and whereas the action of smoking can
be targeted directly (e.g., it can be prohibited in public
places) targeting obesity would target the obese
person, not the behaviors leading to obesity. Focusing
on obesity directly, instead of on behaviors that are
healthy whether or not a person is obese (e.g., physical
activity, eating a balanced diet) may increase the social
stigma already attached to obesity.
Those measures that aim to promote a healthy lifestyle
in general, without focusing on overweight or
emphasizing obesity, are often more acceptable, not
only from the point of view of stigmatization but also
from the perspective of fairness, as all participants
may benefit from such measures. Healthy lifestyles
are, after all, also healthy for slim children. We are
aware that this can be used as a sham argument: pretending
that “ of course it is not focusing on overweight
” , although actually it is.
Targeting vulnerable groups is also sensitive from
the stigmatization angle. ( “ You get breakfast at school
because your parents don ’ t care for you and they are
poor. ” ) Special attention to the justification and possible
effects is necessary. Targeting, however, may
sometimes be necessary, even ethically required, in
order to reach persons and groups that will not be
reached by general measures or programs. For
American Indian and Alaska Native children, The
American National Centre for Chronic Disease
Prevention and Health Promotion designed “ The
Eagle ’ s Books ” program. To quote from the program:
“ The eagle represents balance, courage, healing,
strength and wisdom, and is seen as a messenger or a
teacher. In the Eagle Book series, the wise bird teaches
children how to use these values to prevent diabetes
and grow safe and strong. … Mr. Eagle reminds the
young boy of the healthy ways of his ancestors. ” 17
Will children across the whole BMI range profit from
the measure (even if they do not lose weight) because the
proposed measure increases their possibilities/options for
a healthier lifestyle? Or will they just hear that they are
too heavy?
Measures to do something about obesity might
reinforce stigmatization as, whatever measures are
proposed, the underlying idea is that children should
not be overweight and certainly not fat. What does this
mean for those who already are fat, for example, children
that are born in families where everyone has been
obese for generations and did very well, thank you?
What price will such children pay if the strongly promoted
image is that one should not be overweight?
Take, for example, the Singaporean “ Trim and fit ”
campaign, which mentions on its website that overweight
children “ tend to be clumsy ”. Parents are
informed that “ trim and fit children ” are not only
healthier and feel better, but also look better. 18
Programs like “ Epode ”, the French cities that aim
to be a motivating environment for a healthy lifestyle,
19 are interesting examples of programs that
would provide positive answers to the above questions.
Another positive example is the “ Kids in
balance ” campaign from the Netherlands, which
offers workshops to promote an active lifestyle for
children. It stresses emotional health, instead of focusing
on overweight. To quote from the program:
“ Feeling good about yourself, being emotionally fit, is
just as important as eating brown bread and doing
sports! ” Those who do not lose weight but do develop
a healthier lifestyle are not stigmatized as the “ losers ”,
“ the ones for whom the program did not work ”. 20
Several experts argue that negative, stigmatizing
and scary campaigns are not only ethically problematic
but also ineffective. Instead, people need positive
tools and motivation to work on behavior change.
Parental i nvolvement
The third cluster of questions has to do with parents.
In some cases, individual parental involvement is
not an issue as the measure is on a very general level,
for example, restricting commercials for sweets on
television at certain hours. Parents are involved in a
general way as citizens, of course, but not in a more
personal, individual way. Other interventions,
however, do involve the individual parents. After all,
programs directed at informing children about a
healthy diet and the importance of physical exercise
are unlikely to be sufficient as long as the parents are
not involved. What is the use of knowing that vegetables
contain vitamins when all that is ever offered at
home are French fries?
Is it possible to inform and/or involve parents without
undermining their parental autonomy? Can they be
involved in a respectful way? Can they be convinced
instead of overruled or bypassed?
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