Preventing Childhood Obesity - Evidence Policy and Practice.pdf

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No country for fat children? Ethical questions concerning community-based programs to prevent obesity the direct prevention of harm is at stake. But many parents find it more difficult when it comes to restricting or denying pleasures. However, this is something the child will have to accept in his or her life. If it is not “ no ” to the sweets, it will be “ no ” to something else. One will have to live with requests being refused from time to time. This means that one has to illustrate the advantages of self - control: the enjoyment of tasting instead of the “ mindless stuffing ” , the idea that you are not the victim of habit, feeling or an urge stronger than you, but that you are the master of yourself. That is a reward in itself. Also, control is more effective if embraced rather than imposed. Self - control actually increases freedom. And it also has to be compared to the alternatives: bariatric surgery at the age of 14 is not an attractive proposition. This does not mean that one can rely on self - control and that it is, therefore, not necessary, for example, to remove soft drinks vending machines in schools. But removing the vending machines without changing the idea that one needs gallons of soft drinks every day is not helpful either. However, we also want to stress that the importance of engendering self - control and carefulness in relation to eating should not be conceived in an overly moralistic frame. Many obese adults and children do exhibit self - control and carefulness even in their eating. Although they eat too much for their caloric needs they do so in a controlled way. They do not stuff themselves but have become habituated to eating large portions. So what is needed in many cases is to re - set the perception of what is a normal meal. Proportionality The fifth question concerns proportionality: Is there a balance between the goals, the chosen methods and the possible ethical impact? Can a certain goal be reached with less intrusive measures? For example, to take all children with a BMI above 28 out of parental care and raise them in foster families or clinics is clearly disproportional (apart from being quite unrealistic). How can one evaluate proportionality? The Nuffield Council has designed a framework to evaluate public health measures that can be used in the debate. It is a ladder that indicates different levels of intrusiveness, from “do nothing ” up to “eliminate choice ” . The higher up the ladder, the more intrusive a program is and the stronger its justification needs to be. 24 We want to emphasize the distinction of enabling versus enforcing. Enabling v ersus e nforcing Enabling means that the opportunities are provided for children and parents to choose the healthy habit or lifestyle, whereas enforcing means they have no choice. There are important arguments to prefer enabling to enforcing. The chances that a certain healthy lifestyle or certain eating habits will be integrated, incorporated or embraced is greater if people themselves learn to appreciate them and feel better, enjoy the advantages, rather than when they feel they are submitting to dictates put upon them by others as the internal motivation may then be lacking. Slippery s lope The sixth question regards the slippery slope: Are the measures sensitive to the argument of the slippery slope? The slippery slope concept is that if one measure or intervention is permitted then this will result in further, more intrusive measures being taken in the future which would then significantly infringe upon an important right or ethical principle, such as adults choosing whether to exercise or not. Fears of “ 1984 ” , total health control, or moral imperialism are enlisted in this argument along with the notion that we will all die sooner or later and that there is no point in living a frugal life with no pleasures. These slippery slope fears are often accentuated when proposed interventions are either novel or vague in their definitions and boundaries. In many areas of public health, especially for injury prevention, tobacco control, and to some extent infectious disease control, regulations are enacted which place restrictions on individual behaviours in addition to changing the environment. Influencing personal choices regarding behaviour is also used in the prevention of overweight. This varies from the subtle pushing message “ Please take the stairs ” that one may encounter as health promotion notices at the base of the stairs 25 , to employers forcing their employees to walk by locating the cafeteria far away from the 37
Chapter 4 office building 26 , to imposing a ‘fat tax ’ on fattening foods 27 , imposing higher insurance premiums for obese people 28 or banning cars from city centres and around schools 29 . With programs requiring physical exercise for obese adolescents in Singapore 30 and university diplomas being withheld from obese students in Pennsylvania 31 , it is understandable that people are concerned about a slippery slope in directive programs for the prevention of obesity. Although fear of a slippery slope does not imply that there is an actual risk of a slippery slope, it is important to discuss whether enough safeguards against heading down slippery slopes have been incorporated, and whether the limits of the intervention are clearly communicated to the public. Conclusion These six issues are aimed at inspiring and structuring debate on the ethical presuppositions and goals of measures. They are not a simple set of criteria to be passed in order to have ethical “ approval ” . Within the process of developing and testing interventions to prevent overweight among children, it is crucial to pay attention to their normative aspects. Ethical analysis will help to develop measures in line with values that are deeply important to many of us. That analysis is worthwhile in its own right, and may also contribute to effectiveness. References 1 Elliot F : Parents of fat children to be given a warning . The Times , 2007 (22 October). www.timesonline.co.uk (accessed 9 July 2008). 2 Simpson J : Lose weight or we ’ll take all six of your children away: outrage over social workers ’ “draconian ultimatum ” to parents . The Daily Mail , 2008 (24 March). www. dailymail.co.uk (accessed 9 July 2008). 3 Johnson A : Setting the standard for school food . Department for Children, Schools and Families. 2006 (19 May). www.dfes.gov.uk/pns/DisplayPN.cgi?pn_id=2006_0074 (accessed 9 July 2008). 4 CBBC Newsround. School bans all unhealthy snacks (updated 31 August 2005 ). http://news.bbc.co.uk/cbbcnews/ (accessed 9 July 2008). 5 Walsh B : Singapore shapes up: the lion city ’ s aggressive government programs show the benefits of a concerted, nationwide war on fat . Time Asia Magazine . 2004 (1 November). www.time.com/time/asia/covers/501041108/ obesity_singapore.html (accessed 9 July 2008). 6 Hall S : Stomach surgery and drugs for children to tackle obesity epidemic . The Guardian . 2006 (13 December). www.guardian.co.uk (accessed 9 July 2008). 7 Holm S : Parental responsibility and obesity in children . Public Health Ethics 2008 ; 1 : 21 – 29 . 8 Parents step up. Parents Step Up/Familias en Marcha, an innovative, bilingual, childhood obesity public information campaign in South Florida . 2005 . www.parentsstepup.com/ ad.html (accessed 9 July 2008). 9 Nestle , M : What to Eat: An Aisle - By - Aisle Guide to Savvy Food Choices and Good Eating . New York : North Point Press 2006 . 10 United Nations system of organizations. Global Prevention Alliance: Call to action on the marketing to foods and beverages to children . 2006. www.unsystem.org/scn/Publications/ AnnualMeeting/SCN34/global_prevention_alliance.doc (accessed 9 July 2008). 11 Mikkelsen L , Merlo C , Lee , V , Chao C : Where ’s the fruit? Fruit content of the most highly advertised children ’ s food and beverages . Prevention Institute. 2008 Jan. www.preventioninstitute.org/sa/fruit/wheresthefruit.pdf (accessed 9 July 2008). 12 De Beaufort ID : Individual responsibility for health . In: Bennett R , Erin CA eds. HIV and AIDS, Testing, Screening and Confidentiality . New York : Oxford University Press , 1999 : 107 – 24 . 13 ten Have M , de Beaufort ID : Hogere premies, goedkope worteltjes en bemoeizuchtige collega ’ s: eigen verantwoordelijkheid in de aanpak van overgewicht [Personal responsibility in the prevention of overweight]. Hartbulletin, 2007 Aug; 38 (4). 14 Private Sector EU Pledge : Food and drink companies pledge to change advertising to children (Press Release) 2007 (11 December). www.fachverbandwerbung.at/mmdb/1/2/ 602.pdf (accessed 9 July 2008). 15 World Health Organization : Global strategy on diet, physical activity and health . 2004 May. www.who.int/ dietphysicalactivity/strategy/eb11344/strategy_english_web. pdf (accessed 9 July 2008). 16 Berkeljon S , Vos C . Klink stopt financiering kliniek voor obesitas (Klink stops funding for obesity clinique) . De Volkskrant . 2007 (8 June). www.volkskrant.nl (accessed 9 July 2008). 17 National Center for Chronic Disease Prevention and Health Promotion: The eagles nest campaign . 2007 . www.cdc.gov/ diabetes/eagle/index.html (accessed 9 July 2008). 18 Keep your child trim and fit. Program to prevent childhood obesity . www.hpb.gov.sg/health_articles/trim_and_fit/ (accessed 9 July 2008). 19 Ensemble, Prévenons l ’Obésité des Enfants: Prevention progam in French cities . www.epode.fr (accessed 9 July 2008). 20 Balance Matters: Kids in balance campaign . www.balancematters.org/index.php?option=com_content&task=view&i d=12&Itemid=26 (accessed 9 July 2008). 38
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Preventing Childhood Obesity Eviden
Page 6 and 7: Preventing Childhood Obesity Eviden
Page 8 and 9: Contents Foreword, vii Contributors
Page 10: Foreword Obesity became a major hea
Page 13 and 14: Contributors Rob Carter PhD Head, H
Page 15 and 16: Contributors Shiriki Kumanyika PhD,
Page 18: Preface If we had all the evidence,
Page 22 and 23: CHAPTER 1 The c hildhood o besity e
Page 24 and 25: Childhood obesity epidemic Table 1.
Page 26 and 27: Childhood obesity epidemic explain
Page 28 and 29: Childhood obesity epidemic Table 1.
Page 30 and 31: Childhood obesity epidemic hepatiti
Page 32 and 33: Childhood obesity epidemic 15 Shiel
Page 34 and 35: CHAPTER 2 Lessons from the c ontrol
Page 36 and 37: Lessons from the control of other e
Page 42 and 43: Childhood obesity prevention overvi
Page 50 and 51: CHAPTER 4 No c ountry for f at c hi
Page 52 and 53: No country for fat children? Ethica
Page 60 and 61: A human rights approach to childhoo
Page 62 and 63: A human rights approach to childhoo
Page 64: A human rights approach to childhoo
Page 67 and 68: Part 2 community and government age
Page 69 and 70: Chapter 6 Questions Evidence needed
Page 71 and 72: Chapter 6 ioral determinants rather
Page 73 and 74: Chapter 6 These issues are particul
Page 75 and 76: Chapter 6 15 Carrel AL , Bernhardt
Page 77 and 78: Chapter 7 at the state level to app
Page 79 and 80: Chapter 7 prevention efforts, parti
Page 81 and 82: Chapter 7 interventions. This appro
Page 83 and 84: CHAPTER 8 Evidence of the i nfl uen
Page 85 and 86: Chapter 8 choices in adolescence, 1
Page 87 and 88: Chapter 8 itself is unlikely to res
Page 89 and 90: Chapter 8 20 Cullen K , Baranowski
Page 91 and 92: Chapter 9 meal frequency, decreased
Page 93 and 94: Chapter 9 were behavioral (parent -
Page 95 and 96: Chapter 9 changes regarding partici
Page 97 and 98: Chapter 9 36 Campbell KJ , Hesketh
Page 99 and 100: Chapter 10 condition obesity in chi
Page 101 and 102: Chapter 10 the release of energy an
Page 103 and 104: Chapter 10 whereas Flynn et al 25 a
Page 105 and 106: Chapter 10 11 Baranowski T : Advanc
Page 107 and 108:
CHAPTER 11 Obesity p revention in s
Page 109 and 110:
Chapter 11 translation (see Chapter
Page 111 and 112:
Chapter 11 overweight and obesity r
Page 113 and 114:
CHAPTER 12 The p revention of c hil
Page 115 and 116:
Chapter 12 Selective prevention pro
Page 117 and 118:
Chapter 12 Table 12.1 Recommendatio
Page 119 and 120:
Chapter 12 Table 12.1 Continued Gui
Page 121 and 122:
Chapter 12 short - and long - term
Page 123 and 124:
Chapter 12 33 Woo KS , Chook P , Yu
Page 125 and 126:
Chapter 13 There is a relatively sm
Page 127 and 128:
Chapter 13 Modifying the b uilt e n
Page 129 and 130:
Chapter 13 capacity to support chil
Page 131 and 132:
Chapter 13 45 Staunton C , Hubsmith
Page 133 and 134:
Chapter 14 Changes in the food envi
Page 135 and 136:
Chapter 14 Promising interventions
Page 137 and 138:
Chapter 14 10 USDA - ERS : Food CPI
Page 139 and 140:
CHAPTER 15 Food and b everage m ark
Page 141 and 142:
Chapter 15 Box 15.1 The findings of
Page 143 and 144:
Chapter 15 Food, however, is not to
Page 145 and 146:
Chapter 15 competitive analysis eac
Page 147 and 148:
Chapter 15 behaviour: exploring the
Page 149 and 150:
Chapter 16 pawn or sell possessions
Page 151 and 152:
Chapter 16 obesity and that this ma
Page 153 and 154:
Chapter 16 impact of this deprivati
Page 155 and 156:
Chapter 16 10 Marin - Leon L , Sega
Page 157 and 158:
CHAPTER 17 Socio - c ultural i ssue
Page 159 and 160:
Chapter 17 The s ocio - c ultural e
Page 161 and 162:
Chapter 17 with limited access and/
Page 163 and 164:
Chapter 17 What else can be done to
Page 165 and 166:
Chapter 17 55 Grier S , Kumanyika S
Page 167 and 168:
Chapter 18 Ironically, these countr
Page 169 and 170:
Chapter 18 key environmental factor
Page 171 and 172:
Chapter 18 countries precludes the
Page 173 and 174:
Chapter 18 7 Jafar TH , Qadri Z , I
Page 176 and 177:
CHAPTER 19 Evaluation of c ommunity
Page 178 and 179:
Evaluation of community-based obesi
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
CHAPTER 20 Economic e valuation of
Page 188 and 189:
Economic evaluation of obesity inte
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
CHAPTER 21 Monitoring of c hildhood
Page 196 and 197:
Monitoring of childhood obesity Non
Page 198 and 199:
Monitoring of childhood obesity Noo
Page 200 and 201:
Monitoring of childhood obesity Tab
Page 202 and 203:
Monitoring of childhood obesity 11
Page 204 and 205:
Knowledge translation and exchange
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
The role of advocacy Why d o w e n
Page 214 and 215:
The role of advocacy mate long - te
Page 216 and 217:
The role of advocacy position put o
Page 218:
The role of advocacy 6 Yach D , Haw
Page 221 and 222:
Part 4 infrastructure, funding or r
Page 223 and 224:
Chapter 24 by examining why policy
Page 225 and 226:
Chapter 24 has privileged the manuf
Page 227 and 228:
Chapter 24 case study is an analysi
Page 229 and 230:
Chapter 24 by being highly visible
Page 231 and 232:
CHAPTER 25 Developing the political
Page 233 and 234:
Chapter 25 Involuntary: all society
Page 235 and 236:
Chapter 25 Shiriki Kumanyika and co
Page 237 and 238:
Chapter 25 The next steps Given the
Page 239 and 240:
CHAPTER 26 Community i nterventions
Page 241 and 242:
Chapter 26 Table 26.1 The health pr
Page 243 and 244:
Chapter 26 consider and build on th
Page 245 and 246:
Chapter 26 programs and messages be
Page 247 and 248:
Chapter 26 Victoria, Australia. The
Page 249 and 250:
Chapter 26 participants for appropr
Page 251 and 252:
CHAPTER 27 Community c apacity b ui
Page 253 and 254:
Chapter 27 level and macro - change
Page 255 and 256:
Chapter 27 & Chomp ” where the co
Page 257 and 258:
Chapter 27 Box 27.4 Excerpt from Go
Page 259 and 260:
Chapter 27 Table 27.1 Capacity buil
Page 261 and 262:
Chapter 27 38 Borys Jean - Michel :
Page 263 and 264:
Chapter 28 Box 28.1 The EPODE progr
Page 265 and 266:
Chapter 28 Figure 28.1 For parents:
Page 267 and 268:
Chapter 28 Figure 28.2 Promoting ph
Page 269 and 270:
Chapter 28 marketing, there is ofte
Page 271 and 272:
Chapter 28 social problems. The art
Page 273 and 274:
Chapter 29 length gain observed in
Page 275 and 276:
Chapter 29 tissue deposition relate
Page 277 and 278:
Chapter 29 A study in the USA found
Page 279 and 280:
Chapter 29 7 Cole TJ , Bellizzi MC
Page 281 and 282:
Chapter 29 environmental approaches
Page 283 and 284:
Chapter 30 it all on their own, sin
Page 285 and 286:
Chapter 30 Forty - three countries
Page 287 and 288:
Chapter 30 Box 30.2 Elements of the
Page 289 and 290:
Chapter 31 childhood obesity rates
Page 291 and 292:
Chapter 31 became inactive or was t
Page 293 and 294:
Chapter 31 healthy diets and portio
Page 295 and 296:
CHAPTER 32 Working with m inority g
Page 297 and 298:
Chapter 32 and reflect the circumst
Page 299 and 300:
Chapter 32 inclusion and exclusion
Page 301 and 302:
Chapter 32 3 Mercer SL , Vinney JD
Page 303 and 304:
Chapter 33 % of total DALYs lost 2
Page 305 and 306:
Chapter 33 Finally, within a given
Page 307 and 308:
Chapter 33 urbanized and have aband
Page 309 and 310:
Chapter 33 Box 33.1 Recommendations
Page 311 and 312:
CHAPTER 34 Preventing c hildhood o
Page 313 and 314:
Chapter 34 with a plateau in cigare
Page 315 and 316:
Chapter 34 segments of the populati
Page 317 and 318:
Index academic performance 11, 264
Page 319 and 320:
Index evidence-based and evidence-i
Page 321 and 322:
Index community-based 33, 58, 151,
Page 323 and 324:
Index parental support 67 PE 25, 81
Page 325:
Index Minnesota Heart Heath Project
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