Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Addressing the Panic about 'Obesity': Policy to Protect Health

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Addressing the Panic about 'Obesity': Policy to Protect Health

Article excerpt

Introduction

The scenarios for moral panics change but in the history of such panics, areas of commonality can be seen and are certainly characteristic of panic about obesity (Rosenberg 1992). In many moral panic scenarios there is, at some level, a real problem. Experts have fundamental disagreements about the nature, cause, consequences and appropriate responses to the problem and these disagreements are researched and argued in academic fora. At the same time the media "feasts" on the topic; on one level as a voice for the debate but also as a mechanism for creating a feedback loop in which widely perpetrated myths become accepted wisdom and the public (and many health professionals) are unlikely to attempt to access objective information. In most western nations the media frenzy about body size has reached historic levels with television especially, featuring more and more 'reality' programs which purport to address the crisis of obesity and lifestyle.

Over the last thirty or so years health has changed from being a passive to an active status. Achieving and maintaining good health has evolved from being a matter of good luck to being the product of good management. Rather than seeing an individual as the victim of an unhealthy environment it is now more likely that we will consider that individual's failure to take adequate precautions in terms of a wide range of possible behaviours including smoking, eating, sleeping, and being sedentary. Hansen and Easthope (2007, 11) note that avoiding disease through personal effort has become the predominant discourse when speaking and writing about health. Interest in personal responsibility has been further fueled by the changing demographic in which there are now increased numbers of older people with greater propensity for costly degenerative diseases.

For many years the greatest myth perpetuated in some academic and all populist fora has been that body size, unlike any other human variation, is a matter of choice. Underpinning the notion that body size can be chosen is the seemingly self evident statement that maintaining a "normal" weight is a simple matter of balancing energy ingested with energy expended. Once this is accepted the scene is set for a scenario of blame and condemnation of larger individuals who are then presumed to eat excessively and to be inactive. Because a number of chronic diseases are considered to be closely associated with large body size, it has become possible to blame large people, not only for their personal failings, but also for the considerable challenges currently confronting health systems. In addition such a mind-set has, until comparatively recently, limited or constrained the nature of questions posed in the field of obesity research and the lack of primacy given to particular research evidence.

For many years a steady stream of research evidence has contradicted our taken for granted assumptions. There is extensive research to show that body size and fat distribution is genetically determined, that reduction dieting is not only futile but also makes a significant contribution to increasing body weight and to distorted attitudes towards food and body image. There is also research evidence that the relationship between body size and health is poorly understood, frequently portrayed inaccurately and not yet fully understood (Cogan and Ernsberger 1999; Ernsberger and Koletsky 1999; Campos et al. 2006; Troiano et al. 1996; Gard and Wright 2005). No RCTs or other source of reliable evidence exist which conclusively prove the relationship between energy in and energy out (Grundy et al. 1999; Gard and Wright 2005)

In summary, neither the cause nor cure for obesity has ever been agreed. The connection between large body size and poor health is not at all clear-cut and has not been adequately separated from the characteristics of an individual's lifestyle or socio-economic status in research scenarios. …

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