Ethical considerations in the prevention of childhood obesity

[摘要] ENGLISH ABSTRACT: Childhood obesity is a global pandemic, the prevention of which is a public health priority.The aim of this thesis is to explore the ethical issues that arise when designing,implementing and assessing public health interventions to prevent childhood obesity. Aschildhood obesity is a social justice issue, ethical analysis of such interventions must utiliseframeworks with a social justice orientation.Public health ethics differs from ethics at the individual level therefore moral theories used inindividual medicine are unsuitable for application in public health. The well-being theory ofsocial justice recognises that there are multiple causes of systematic disadvantage, not justin health, but in social, economic and political aspects of life and requires that we addressthese social and economic determinants which compound insufficiencies in wellbeing. Thisis particularly relevant in interventions targeting childhood obesity, as evidence has shownthe impact of socio-economic and environmental factors as a major contributor to the problem.Where moral theory may not be able to provide enough concrete guidance, the use of ethicalframeworks is of practical assistance. Ethical frameworks compatible with different moraltheories and incorporating an analytic tool would be particularly useful in the South Africanpublic health context. Three such ethical frameworks are those of Nancy Kass, NuffieldCouncil on Bioethics, and Andrew Tannahill. These are compared for ease of use,applicability to different stages of interventions and specific relevance to childhood obesity.An ethical problem in childhood obesity interventions is the issue of who is responsible forchildhood obesity. The personal responsibility paradigm is problematic, as it ignores socialdeterminants of health leading to childhood obesity and results in victim-blaming. The role ofthe parents and the extent to which the state should intervene when childhood obesity isregarded as medical neglect are considered.Obesity prevention as a societal responsibility has ethical implications for government,schools, industry and society in addressing the obesogenic environment. The ethics of foodadvertising and marketing to children in South Africa in particular exploits the vulnerability ofchildren and is aggravated by ineffective regulation and insufficient legislation.Stigma associated with childhood obesity has become a well-documented phenomenon andis another major ethical concern. A good understanding of stigma is provided by Link andPhelan's conceptualisation, all the components of which occur in childhood obesity.Stigmatisation of obese youth is pervasive, occurring across multiple domains and from various sources, and results in adverse psycho-social, academic and physical consequences.Two aspects of stigma from a public health perspective are considered. The first is the perpetuation of stigma through the preference of certain health identities. The second is its adverse effects on public health efforts, resulting in increased morbidity and mortality. Evidence shows that stigma is harmful on the individual and the public health level and is neither useful nor ethical as a motivator for weight loss. Stigma reduction is recommended in the planning and assessment of childhood obesity interventions.I conclude that the prevention of childhood obesity in South Africa is a matter of social justice and that interventions be assessed by the Nuffield Council on Bioethics' Stewardship framework.

[发布机构] Stellenbosch University