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Case study: obesity Lord Krebs Kt FRS FMedSci Chair of the Working Party on Public health: ethical issues Principal, Jesus College, University of Oxford Background • Obese = BMI ≥ 30 • Risk factor for range of chronic diseases • 30,000 deaths a year in England are attributable to obesity • 23% of men and women were obese in 2004 – trebled since 1980s • Childhood obesity increased from 10% in 1995 to 14% in 2003 Causes of obesity Highly complex causes: • Food high in fat and sugar is cheaper and more available • Eating out more • Food is lower in protein • Bigger portions • Advertising • Changes to transport patterns • More lifts, escalators • Reduction in manual jobs • Labour-saving devices Need ethical framework to determine intervention Protecting children • Obesity in children is a particular concern • Schools are part of the bigger picture • Conclusions: – Schools should encourage a more positive culture towards food, cooking and physical activity – Weighing young children is crucial but reduce risk of stigmatisation – Develop criteria for intervening in the home Role of industry • Consumer choices are influenced by availability and marketing • The food industry has an ethical duty to help individuals to make healthier choices • Conclusions: – Food industry should adopt the most effective labelling scheme, and if it does not, there is justification for legislation Role of Government • Energy expenditure levels have decreased • Measures to increase expenditure: – segregating walking and cycling routes from heavy traffic – car-free zones in city centre – maintaining playgrounds • Conclusion: – town planners and architects should be trained to encourage people to be active through design of buildings and spaces Costs to the NHS • Obesity costs the state billions each year: should obese people be denied NHS treatment? • Obesity has complex causes • Unfair ‘victim blaming’ and risk of stigmatisation • Conclusion: – Not appropriate for obese people to be denied treatment – Appeals to change behaviour could be justified if help offered