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Obesity, political responsibility, and the politics of needs

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Abstract

Since overweight and obesity have been framed as one of the main contemporary health challenges in industrialized countries, it has become a matter of public health efforts. While the belief that obese individuals are personally responsible for their body weight prevails in public opinion, evidence-based health science widely acknowledges that obesity is significantly influenced by socio-economic factors and thus that prevention requires structural changes. This constellation bears the chance of politicizing an issue formerly conceived of as private which really is dependent on societal contingencies, such as the particular availability of food. Reflecting on the prevention of obesity from an ethical point of view, therefore, requires an elaborate concept of political responsibility. The core thesis of this paper is that existing approaches within the field of obesity ethics fall short in reasonably grasping the political dimensions at play, due to the prevailing individualistic understanding of responsibility. Drawing upon Iris Marion Young’s concept of political responsibility, I propose an alternative approach that emphasizes the structural determinants of obesity. By arguing this way, obesity prevention comes into view as a public endeavor that involves public discourse as well as shared action. Political responsibility then cannot be discharged merely by intrusive governmental action nor by individuals on their own, but should be considered as a task all of us share. As I will sketch in the last part of the paper, this includes contesting discourses on interpretations of need. Thereby, the paper contributes to recognizing obesity as a social instead of an individual problem.

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Notes

  1. Available data suggests that since the early 2000s, the prevalence of obesity has stabilized on a high level in developed countries (Rokholm et al. 2010; Ng et al. 2014). For an overview of health risks related to obesity see: (World Health Organization 2000).

  2. For an excellent application of the concept of obesogenic environments to the phenomenon of childhood obesity see: (Voigt et al. 2014, pp. 111–132).

  3. That the relationship between socio-economic status and obesity is considerably stronger for women than for men is often traced back to gender-specific differences in how bodies are valuated. Generally, the female body is societally subjected to an ideal of slenderness, while a big and large male body can to some degree also be associated with power and dominance (cf. McLaren 2007, p. 37f).

  4. Because the preparation of food and child care is traditionally deemed a female task that is still primarily undertaken by mothers in most families, it has often been noted that appealing to parental responsibility for healthy nutrition in childhood places an unequal burden on women (cf. Reiheld 2015, p. 232).

  5. To do justice to the ten Have-framework, there liberty serves as only one of eight values conceivably at stake in obesity prevention programs. In principle, stakeholders evaluating a particular program informed by the questionnaire can even accept restrictions, for instance, because they are convinced that those are appropriate for serving other favorable purposes.

  6. In this sense, civic people are responsible for calling public institutions for justice promoting action (cf. Young 2011, p. 169).

  7. Governmental intervention such as regulating food marketing practices then should only take place in a second step for the sake of remedying incompatible stakes such as the conflict between health orientation and profit maximization food industry has to face. They then should be presented “not as a restriction or even a penalty imposed on actors who have failed to show voluntary restraint and social responsibility, but instead as an enabling measure that recognizes the impossibility of fulfilling incompatible goals.” (Voigt et al. 2014, p. 78).

  8. This is overlooked when Callahan (2013, p. 39f) even advocates putting social pressure on obese individuals while not questioning the goal of weight reduction.

  9. Fraser is a pertinent reference because in Youngs’s account, the connection to social welfare as provided by the government is underexplored, which is substantial regarding obesity.

  10. For instance, compared to so-called normal weight, moderate obesity seems to have no significant effect on mortality, while non-obese overweight seems to be associated with even lower mortality (Flegal et al. 2013). In addition, satisfaction with one’s own body weight seems to be a stronger predictor for physical as well as mental health than a body mass index value (Muennig et al. 2008).

  11. Furthermore, they try to establish empowering ways of appropriating a fat identity beyond pathologization and guilt. With the emerging field of fat studies as a specific branch of diversity studies, the political claims of the fat-acceptance movement have found an academic prolongation (cf. Rothblum and Solovay 2009). Fat studies can be very important for establishing a counter-discourse and scrutinizing widespread ideologies of weight bias. Nevertheless, it seems that they focus on analyzing the social effects of being fat and reconstructing how fatness has discursively been formed as a perceived problem. However, they disregard that socio-economic factors also materially condition the development of obesity. Therefore, within fat studies, a tendency to forbid even thinking about problems concerning health injustice manifesting in obesity prevails (cf. Wann 2009, p. 17). This risks bringing about the same problem they hold against the tendencies of healthism: That is relinquishing the issue of social inequality from political discourse, and thereby depoliticizing a runaway need, instead of establishing alternative political claims of social welfare.

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Acknowledgements

I would like to thank Anne Cress, Danielle Norberg, Lisa Neher, Antje Géra, Eva-Maria Scheiber, Elisabeth Conradi, Oliver Honer, and the anonymous referees for this journal for their comments on previous drafts of this paper.

Funding

This paper is part of project “Ethical aspects of the prevention of obesity in Europe. A comparison of the situation in Western and Eastern Europe in selected countries” (Award No. 01DS17005) that has been funded by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung). The responsibility for the publication’s content lies with the author.

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  1. Faculty of Social Work, Health Care and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany

    Kaja Tulatz

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Tulatz, K. Obesity, political responsibility, and the politics of needs. Med Health Care and Philos 22, 305–315 (2019). https://doi.org/10.1007/s11019-018-9877-3

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