Obesity Epidemic in America: When Does the Individual Take Responsibility?

Abstract

This paper examines who is responsible for the growing obesity epidemic that has affected and continues to affect millions of people. Some people blame the obese individuals themselves, and others place blame on the environment, social, and government factors. Some of these environmental factors consist of unhealthy fast food and junk food options that are readily available, the lack of sidewalks, the lack of affordable exercise programs, and the lack of healthy food options. When looking at responsibility, there are a few concepts and terms that will be analyzed and applied to people suffering from obesity. The studies gathered came from either obese individuals or the general population, which asked questions centered around who should be blamed for the obesity epidemic or what environmental factors should be changed in order to manage and/or prevent obesity.

Introduction

Obesity is a growing epidemic that effects millions of people worldwide and many believe that it is a choice. Individuals also believe that those who are obese or severely overweight should be held personally responsible for their weight gain and their poor dietary habits as well as their lack of physical activity. Due to the previous factors, it is seen as a clutch to the health system because of the various cost that is associated with NCD (non-communicable disease) and the other medical issues that it can cause. Medically, obesity is a healthcare issue that can lead to someone’s demise and the other medical issues associated with this issue is heart disease, diabetes, high blood pressure, sleep apnea, and many others.

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In some people who suffer from obesity, they believe that outside factors are responsible for them being obese. Those outside factors consist of non-healthy affordable food options and gym memberships being unaffordable. Other factors presented are the guilt and embarrassment when an obese individual goes into public because they are constantly feeling judged by the public. They are often stigmatized by society as being lazy, having no pride or respect for self, or just plain out right nasty. Many obese individuals can agree that they are initially responsible for their condition, and many find it difficult to lose the weight because they feel that many of their choices are taken away, or they have limited options when it comes to loosing and maintaining a healthy weight and leading a healthy lifestyle.

Discussion

Obesity has become an epidemic that affects millions of people worldwide. This epidemic leads to other health concerns such as high blood pressure, diabetes, cancer and other diseases that have extremely negative effects on many scales. These health concerns can also be coined lifestyle diseases because they are diseases that are “associated with the way in which in individual or a group of individuals live” (Arhire, 2015, p. 326). With the increased health diseases associated with obesity, it has led to many people attempting to find a solution to this epidemic. Where does one start to address the issues and who is responsible for the growing obesity crisis? Some individuals look at the social and environmental factors as the main contributing force behind people becoming obese. These social and environmental factors consist of the lack of affordable and healthy food options that are available as well as the lack of affordable and accessible exercise options. Other factors are the amounts of sugar and processed foods that companies place in food that may add addictive properties, which make it difficult to stop drinking and eating those foods. While some look at the social and environmental factors, others believe that it is the personal responsibility of the obese individuals to lose the weight and become healthy as to minimize the negative health effects of being overweight. And while the views amongst people may differ, the individuals who believe that the blame falls on the obese person also believe that society does not own them any compensation due to their personal choice of becoming and staying obese (Nielsen & Andersen, 2014).

In this discussion, we are looking to the question when does the individual take responsibility and is it appropriate to place blame for being obese. In a recent qualitative study where 13 participants were interviewed, it found that many of the overweight and obese individuals deemed it difficult to stay to a diet or to stay active because of previous relapses (Salemonse et al., 2018). They had a fear of trying and failing which was strengthened by repeated efforts and relapses, so this caused them to stop trying and continue to stick to their unhealthy lifestyle (Salemonsen, et al., 2018). In this study, the participants were overweight or obese and had additional health challenges and the same participants did state that they blamed themselves and that they should take more responsibility for their lifestyles. They also had an understanding or knowledge of healthy diets and they knew the importance of being active (Salemonsen, et al., 2018).

In another study that was conducted in New Zealand with 534 participants, which tested measures to reduce obesity, the participants stated that while the obese individuals should be held responsible that responsibility also fell on the government to impose certain changes. This was an online survey where the panel members were “recruited from a variety of sources and agreed to respond to survey request in exchange for rewards” (Gendall, et al., 2015, p. 2). A five-point scale was used which assessed 15 likely senarios intended to diminish obesity amongst the population (Gendall, et al., 2015). Changes consisted of environmental changes such as fresh fruit and vegetables, easier to read food labels, and healthy food and exercise options that should be more accessible and less expensive (Gendall, et al., 2015). With both the study and the survey, they could be replicated but the results may vary because different individuals would be picked to participate in the study. The important aspect of the first study mentioned was that the viewpoint came directly from the individuals who were overweight or obese.

An additional study looked at how overeating and food addiction was perceived and the effects that it had on picking healthy foods and the choices of picking healthy snacks. In this study a verifiable hypothesis was formulated and was logically deduced from the theory that food addiction causes overeating and obesity. The hypothesis also stated that individuals in the overeating condition would have higher ratings of self-perceived food addiction, assign a lower rank to the addictiveness attribution, and select a less tempting snack to take home with them (Ruddock & Hardman, 2017). The survey consisted of 3 different conditions (overeating, undereating, or control) with 30 participants in each condition to explore the theory that food addiction leads to overeating and obesity. This study further looked at food addiction and if it was linked to increased levels of dietary concern and guilt (Ruddock & Hardman, 2017). The study also predicted that people who overate viewed themselves as having higher levels of guilt and see themselves as being addicted to food, thus explaining their behavior for overeating.

The data gathered from all the surveys suggests that the blame for obesity falls on both the person and the environmental factors. While the evidence gathered from the data suggests that some of the blame lies on the obese person, in an article written by Lidia Arhire, they state that, “in the case of obesity, we should avoid “blaming the victim”; at the same time we should acknowledge the central role of healthy behaviors in maintaining healthy weight” (2015, p. 326). The author states this because victim blaming can lead to feelings of guilt and this would be destructive behavior that could potentially be counterproductive to obese individuals who are attempting to lose weight (Arhire, 2015). Thus, instead of placing blame, there are two approaches that can be taken and those are the medical model and the public health model. The medical model focuses on treatment and the public health model focuses on prevention and looks at the root cause of obesity that may make individuals engage in their harmful health behaviors (Arhire, 2015).

There are additional concepts that are noted when looking at responsibility and the link to obesity. Two of them that we will discuss is the backward-looking and the forward-looking concept of responsibility. The backward-looking concept of responsibility considers the past behaviors and actions of the individual. Nielsen and Andersen state that this approach even looks at genetics and the behaviors of the individual’s parents, grandparents, etc. They affirm that with this concept a person could not be accountable for their actions that placed them in their situation. They suggest that self-responsibility is impossible (Neilson & Andersen, 2014). Linking this concept to self-responsibility and obesity, an individual is obese because of factors outside of their control; they were ‘destined’ to be obese and there was nothing and is nothing they can do to change this.

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The forward-looking concept of responsibility holds the person responsible to take on a lifestyle that will be beneficial to their health; but, this responsibility “will typically mean either that they are subjected to criticism, censure, or other negative appraisals or that they are held cost-responsible in some form” (Neilson & Andersen, 2014, p. 447). The authors continue to explain cost-responsibility, which is holding a person financially responsible if their choices lead to their poor health. This would mean that obese individuals would take responsibility for their current actions and take on a lifestyle that would cause them to lose weight and be healthier. It would also mean that because they are responsible, there is a possibility that they could be denied equal access to health care (Neilson & Andersen, 2014).

In addition to the concepts previously mentioned, there are also two key terms that are looked at when speaking about responsibility and those are liberal egalitarianism and luck egalitarianism. Both principles focus on distributive justice and how a person should receive the goods that are given out in society. The principles of liberal egalitarianism are those of “fair distribution of fundamental rights and duties, as well as the social and economic advantages in a society with free and equal men” (Arhire, 2015, p. 324). Luck egalitarianism states that “the fundamental object of equality is to compensate less fortunate people, namely people who are born with disability, people whose families are in serious distress, people who have been involved in accidents or who suffer from serious diseases. However, if people face poor physical health due to their own fault, then societies need not be compelled to offer them health care services” (Arhire, 2015). Summed up, liberal egalitarianism promotes fairness to everyone, and luck egalitarianism implies that inequalities are unfair unless the unfairness is caused directly by the individual. In healthcare the main principle is that of luck egalitarianism and this would be implied that if an obese person is responsible for their condition then society is not responsible for paying for any health services that is related to their condition (Arhire, 2015; Neilson & Andersen 2014).  When looking at who should be accountable for obesity, some would say that it is not right to blame the individual while some would argue that overweight and obese individuals should accept some of the responsibility while avoiding damaging forms of guilt (Arhire, 2015).

Conclusion

The obesity epidemic has become not only a personal issue, but a public health issue. Salemonsen, et al. (2008) states:

Overweight and obesity present an increased risk to health and are major risk factors for a number of non-communicable diseases (NCDs) including type-2 diabetes (T2DM), cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), some types of cancer, musculoskeletal disorders and mental health problems (p. 1).

The higher cost associated with obesity and the other issues that it can cause places a rise in health care cost to everyone, not just those individuals who are obese. This is where luck egalitarianism comes into play because of the rising healthcare cost connected with obesity.

Considering the data gathered from the surveys, obese individuals are partly to blame for their condition and the other part of that blame falls on the environmental factors that make it difficult for those individuals to lose and maintain a healthy weight and a healthy lifestyle. This difficulty arises due to the guilt associated with failing and the stigmatism that is placed upon them by society; also, obese individuals are easily looked over and are seen as being a burden. “It is easy to forget the person living with overweight or obesity when both the person her/himself and the provider are mainly focused on weight lost treatment” (Ruddock & Hardman, 2018, p. 11). Education is key when dealing with obesity and dealing with the obese individual’s emotions is key so that they can control their physical activity and food intake (Ruddock & Hardman, 2018).  Since this epidemic fall both on the individual and the environment, both should be held responsible and both should work together to find successful measures in order to improve the overall condition.

References

• Arhire, L. I., (2015). Personal and social responsibility in obesity. Rom J Diabetes Nurt Metab Dis. 22(3). 321-331. doi:10.1515/rjdnmd-2015-0039
• Gendall, P., Hoek, J., Taylor, R., Mann, J., Kregbs, J., & Parry-Strong, A., (2015). Should support for obesity interventions or perception of their perceived effectiveness shape policy?. Aust NZ J Public Health. 39. 172-176. doi:10.1111/1753-6405.12319
• Neilson, M.E., & Andersen, M.M., (2014). Should we hold the obese responsible?, Cambridge Quarterly of Healthcare Ethics. 23, 443-451. doi: 10.1017/S09631801134000115
• Ruddock, H. K., & Hardman, C.A., (2017). Guilty pleasures: the effect of perceived overeating on food addiction attributions and snack choice. Appetite. 121, 9-17.
• Salemonse, E., Hansen, B.S., Forland, G., & Holm, A. L., (2018). Healthy life centre participants’ perceptions of living with overweight or obesity and seeking help for a perceived “wrong” lifestyle – a qualitative interview study. BMC Obesity. 5(42). 7-13.