Obesity: a wicked public health problem

Obesity - good or bad?Cl

Updated version here



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Most people view obesity as an unequivocal bad -- both for the person and the public. 

Lines are being drawn in the battle against "big food" just like big tobacco before. The marketers of food are critiqued for over-sized portions, and ironically, similarly critiqued for offering smaller portions.

However, while media and public health and popular views may appear to be generally fairly united in terms of their perception of obesity as the problem, the problem is far more complex than many seem to realise.

What is the problem in the first instance? Obesity is not always viewed as a problem. Some suggest that obesity may be a positive social signal (Mankar et al. 2008), a sign of wealth and status (Wells 2006). Even today in the West, no-one is likely to show concern about babies that are well above the norms for their age in terms of weight.

But the prevalence of obesity is growing rapidly. This is agreed, but the reason why is far from clear. Is it the energy input - e.g., junk food, carbohydrates, highly processed foods, sugars, etc? Or the energy output - e.g., lazy leisure (television, video-games, smart-phones), motorised transport, reduced background exercise (more elevators, more remote controls, more computer-based work, etc)?

And perhaps more significantly, what is the problem posed by increased obesity? The public health view often portrays obesity as a dire condition, but a systematic review (Flagel et al. 2013) suggest that the obesity-mortality relationship is not as strong as some might fear. Others have pointed out that obesity is relatively benign metabolically (Hughes 2008) and that talk of an obesity epidemic has been “overblown” (Gibbs 2005). Obesity may even be apparently protective in some circumstances (e.g., the so-called "fat paradox").

And even if it is decided to be harmful for the individual, on what basis is it right for public health to proscribe individual choices, preferences, pleasures? The claim that obesity costs the public health system does not appear to bear up when life-time health costs are examined (Van Baal et al. 2008).

But let's assume that obesity does harm the public good, and further assume that it is okay for public health and policy makers to direct what may be marketed and what consumers may consume. Are we now not allowing these authorities to promote a leaner body image? How is this acceptable when marketers have been so soundly critiqued for promoting overly-idealistic body images (while being simultaneously critiqued for promoting obesity)?

Perhaps the biggest problem is that dogmatism prevents a real examination of the complex nature of the issue. There are two forms of philosophical scepticism that need to be applied. The first is epistemic, the second is ethical. Dogmatism fails to acknowledge the two forms of uncertainty. In the first instance, judgments are made about what is true (even while evidence is conflicting). In the second, judgments are made by public health and policy makers on what constitutes "good" behaviour and thereby impinge on what is ultimately a very personal decision - how we choose to take on energy and how we choose to expend it.

Obesity and the public health approach to the issue are problematic. The dogmatism adopted both conceals the uncertainties (epistemological and ethical) and confounds the problem.