Introduction
Obesity is a chronic disease, one of the most dangerous today, and it should be treated systematically to prevent losses it causes. In another case, it will continuously reduce the well-being of the population. Being a result of lifestyle changes in modern cities, obesity worsens the life quality of many people, limiting their possibilities and creating a prerequisite for other diseases, such as cardiovascular or mental. It is deeply connected with health inequity and urban health problems, as they create an unhealthy environment, contributing to obesity development. To successfully address obesity issues, a coalition with strong ethical values should be formed.
Factors of Obesity
From a population health perspective, obesity may be considered pandemic: it is widespread both in developed and developing countries as the city population in the world raises. To understand the scale of the obesity problem, there is the fact that over 2 billion people worldwide are suffering from it, which is one-third of the world population, an immense and alarming number (Caballero, 2019). Factors that contribute to health problems, including obesity, are generally called social determinants of health: they describe, quantitatively or qualitatively, the level of health in the population (Thornton et al., 2019). They are very useful in the field of public health, including obesity treatment, as they help to see which issues must be addressed and how to do that. In general, one may specify lifestyle, environmental, economic, financial, and social factors which influence the obesity spread.
Lifestyle factors are connected with the personal life of people: some of its elements make them vulnerable to excessive body mass and all issues connected with it. The main lifestyle changes which cause obesity in modern cities are wrong nutrition and a lack of physical activity (Congdon, 2019). Quality of food is often hard to be maintained in cities, and spoiled products are a frequent problem for its habitats, especially for those limited in their funds (Hurlimann et al., 2017). A lack of food discipline and the abundance of junk and discretionary food also increase obesity risks in cities (Lal et al., 2020). Physical activity is important in obesity prevention: it burns calories, strengthens the body, and reduces cardiovascular tension (Elagizi et al., 2020). To address lifestyle factors, people are to be educated on how to behave to prevent obesity and reduce body mass; all urban facilities, such as sports grounds, should be provided. In that way, they depend on the individual life choices of each person and may be reduced by the right choices, unlike other factors which depend on the person’s surroundings.
Environmental factors are those connected with the place of the population living: for example, living conditions, pollution level, urban health quality. This increase is rarely connected with the increase in health literacy, resulting in the multiplication of existing problems (Congdon, 2019). As mentioned, cities often are not organized for physical activity and health services providing, creating an environment where obesity levels will probably increase. To face environmental factors, one needs to examine problems in city planning, pollution, services availability and explore how the situation may be improved.
Economic and financial factors are also important, as those who have no money to buy well-quality food have a higher risk of various health problems, including obesity. The problem of health inequity is the core of those factors: people who are limited in their funds and social mobility always have higher risks of health issues (National Academies of Sciences, Engineering, and Medicine, 2019). While everybody may be an obesity victim, poor city citizens, ethnic and national minorities, and their children are the most vulnerable (Thornton et al., 2019). Economic factors are deeply interconnected with environmental ones, as poor people are usually living in bad environmental conditions, and those factors, put together, worsen the situation even more. Low income, low social security, lack of insurance and social mobility, limited access to healthcare facilities, clear water, and quality food are specific examples of economic factors which cause obesity (Wilkinson, 2018). To face those factors successfully, one should explore the health inequity problems in each community and work with them to provide more equal opportunities for its members.
Social factors form another category: obesity is connected with severe stigmatization, inequity in access to treatments, and a lack of knowledge in populations about how to cope with it. It is also connected with economical ones: poor communities where people cannot allow health services or increase their health literacy are more vulnerable not only to obesity but also to wrong social relationships, including bullying and stigmatization. Weight discrimination is even more prevalent worldwide than those based on skin color: it makes the social factor an important negative influence that should be faced to prevent obesity (Tomiyama et al., 2018). Stigma has a devastating impact: it increases the obesity level, leading to a rise in body mass index (BMI) in obese people. In addition, it worsens their psychical health, making them even less competitive and drastically limiting their life opportunities for no reason other than their body weight (Rubino et al., 2020). In that way, social factors are based on communication problems in communities and mental issues that may indirectly be caused by obesity. To cope with them, psychological treatment of patients is necessary, along with continuous education to prevent bullying and stigma.
Treating Obesity: A Collaborative Coalition
A collaborative coalition to address obesity may be formulated to efficiently address this concern. It will consist of 5–10 members who are connected with public health, which is an interdisciplinary field. Key community people, such as non-government organizations (NGOs) members, are crucial to represent the actual situation in the population. Stakeholders are those businesses, companies, entrepreneurs who may finance the coalition, being interested in improving the public health situation: they become the sponsors of the coalition and fill its budget. Clinical providers are those clinics and physicians who are ready to offer their services to people suffering from obesity: these include nutritionists, physical therapists, cardiologists, physiologists, and psychiatrists (Elagizi et al., 2020; Hurlimann et al., 2017; Nimptsch et al., 2019; Tomiyama et al., 2018). All of those physicians are addressing obesity from different perspectives: healthy diet, physical education, physiological problems, and mental issues, which are often the result of obesity. Administrators and organizers also need to regulate the coalition as a whole: organize a constructive environment for realizing its ideas, formulate plans. When formed, the coalition will be able to address obesity problems in the community and resolve them.
Those people are key ones in providing public health, as they together have all the necessary instruments to improve the situation:
- Community and NGOs members are responsible for the population evaluation, obesity problems definition, and creating a list of what should be addressed. At least 2 of them are in need, as they represent the community that will be treated.
- Clinical providers are specialists who are responsible for the actual treatment of obese people: providing medical help, therapy, diets, and other facilities necessary to cope with their problems. At least 5 of them should be included, based on five perspectives that are necessary to address the obesity problem: nutrition, physical activity, physiology, heart issues, and psychology.
- Stakeholders are those responsible for the coalition funding: government and non-government organizations, businesses, investors; the coalition should explicitly define and consider all their interests, and at least one of them is necessary.
- Administrators are responsible for the coalition’s general functioning: communications between its members, considering everybody’s interests, creating and implementing its plans, communicating with various city services and health facilities. At least one administrator should be present, who is the organizer and leader of the coalition.
Together, they will contribute to the goals of the coalition in reducing the obesity widespread in the population, addressing all its aspects, and providing recourses for that. In total, the coalition should include at least eight members.
Potential issues that might arise in the collaboration process may be divided into three categories: communication problems, a lack of competency, and health inequity during the coalition work. The resolving of communication problems is the task of the administrator: for that, each member should clearly understand their interests and duties, and the administrator is responsible for organizing that (Ho & Pinney, 2015). A lack of competency is easy to resolve: physicians’ skills may be evaluated before the invitation to the coalition. Health inequity is a general problem that results from an unequal distribution of goods and opportunities between various social groups (National Academies of Sciences, Engineering, and Medicine, 2019; Wilkinson, 2018). To treat it, the coalition should examine the situation in social groups, identify inequities, for example, lack of access to health facilities or healthy food, and formulate a strategy to cope with each particular inequity.
Treating Obesity: Ethical Issues
To optimize collaboration and communication among coalition members, strategies that face those mentioned issues should be developed. The first is the development of an ethical code and defining the responsibility of each member: those who do not meet their responsibilities will be excluded (Ho & Pinney, 2015). It will also help overcome health inequity: by following its ethical code, the coalition will be able to help those who need help most, such as underserved members of the population. Public health is a complex of measures that should be available for every member of the population; otherwise, its outcomes will not be successful (Wilkinson, 2018). Thus, for the coalition which should be formed, ethical issues are relevant to successfully address its mission in the treatment and prevention of obesity.
Barriers to Health Equity
To ensure that all people will receive equal obesity treatment, the coalition needs to address barriers that may prevent people from obtaining good and qualified health support.
Inequal access to care, financial barriers, environmental constraints, and the unjust distribution of resources are examples of those barriers (National Academies of Sciences, Engineering, and Medicine, 2019). The coalition ethics should promote health equity by coping with those barriers: studying them extensively and then creating strategies for overcoming them.
Ethical Principles: Micro- and Meso-Levels of Interaction
Those are levels of coalition action: micro-level is the communication with individuals who suffer from obesity, and meso- is the general organization of the coalition. Beneficence and non-maleficence are crucial values for the coalition in addressing its mission on a micro-and meso-level. Micro-level considers the individual care encounters, communication with people, and helping them return to their health and loss excessive weight. It works with individual patients’ parameters, such as their temperature or, in the case of obesity, body mass index (BMI) (Ho & Pinney, 2015). An example is the treatment of children from underserved families by volunteers to increase their health literacy and help to cope with possible obesity risks (de la Haye et al., 2019). Thus, interactions on the micro-level are face-to-face communications with those who need help.
Meso-level is about the organization of the coalition: its structure, values, ethic code, plans. Its main idea is to deliver quality care for patients and populations who suffer from obesity, along with education, increasing health literacy, and other mass events for addressing the obesity concern (Ho & Pinney, 2015). Community-based organizations, similar to the coalition described above, are helpful in facilitating the population’s access to medical help (Pearce et al., 2019). Acting on the meso-level includes creating global plans of action, introducing ethical codes, and organizing various events.
Ethical Code for the Coalition
The coalition might utilize the ethic code of public health, which allows them to formulate clear responsibilities for each coalition member. They will help them in their work within the coalition and with the selected population: this code defines a broad system of responsibility, making each member act for the coalition’s good (Ho & Pinney, 2015). Health inequity is an important issue that prevents people with obesity from receiving quality help when they need them: thus, they cannot make their lives better (Wilkinson, 2018). Defining micro-and meso-levels of interaction is helpful, facilitating the interaction with patients: both with individual ones and the community in general. To conclude, the coalition for obesity treatment should have strong ethical values, which are its core: they unite its members and create ways of right actions for them.
Diversion and Inclusion Principles
All cultures, nations, and social groups in the modern world, including developing nations and marginal cultures, are vulnerable to obesity. Principles of diversity and inclusion are applicable to the formation of the coalition, as they facilitate interactions between its members and the community. As mentioned, health inequity is an important issue that aggravates the obesity concern, as those who need treatment most cannot afford it (National Academies of Sciences, Engineering, and Medicine, 2019). Diversity management helps the coalition understand which social groups are underserved, why, and how to address them.
The coalition should either be diverse, including representatives from various social groups, or be able to cooperate and communicate with those groups. Diversity management is deeply interconnected with ethical principles and health equity, which are important when treating obesity, as it is widespread among various social groups. To establish a culture of inclusion, respect, and value in the coalition, its administrator should include respect for all social groups in its ethical code (Stanford, 2020). Two main principles of inclusion in obesity treatment mean that everybody who has enough competence will be able to join the coalition, and everybody who suffers from obesity may receive the appropriate treatment. The advantages of a diverse team are its stability, mutual respect, and the ability to cope with equity issues better.
Community engagement, health equity development, and access to resources are those parameters that should be considered when working with inclusion. Community engagement may be developed by increasing the health literacy of the community and informing it about the causes of obesity and how they may be treated. Health literacy means the knowledge of population members about diseases, their causes, possible treatment options, and where they may find them. Resources can include, but are not limited to, medications, transportation, and environmental resources; those people who cannot afford them due to a lack of opportunities should be able to obtain those opportunities (Wilkinson, 2018). Health equity is developed when each community member obtains equal access to all opportunities; it helps them cope with their obesity problems. To conclude, “soft skills” such as diversity management and ethical communication are important for the effective work of the coalition. Described practices, such as health literacy improvement, community engagement, and diversity management, help the coalition in realizing its principles, in reducing obesity levels and improving the community’s well-being.
Discussion
Literature and research in the field of obesity may be used to develop best practices for addressing this issue. Literature cited in this paper all contribute to the obesity issues from various perspectives, such as public health, obesity development, its prevention. For example, the work of Ho and Pinney (2015) shows the principle of modern healthcare leadership and how the responsibilities are better to be distributed. The article of Pearce et al. (2019) describes how community-based organizations help people obtain medical help and prevent obesity. The papers of Lal et al. (2020) and Elagizi et al. (2020) describe how lifestyle improvement, healthy nutrition, and physical activity, respectively, help in obesity prevention. The article of Wilkinson (2018) discusses health equity issues and how they may be faced. Together, those information shows the problem from various perspectives, which may be used when coping with it.
A comparison of various studies that explore the topic of obesity issues may help in formulating the best strategy for the coalition. Examples of two current, peer-reviewed papers that may be considered foundational to developing an evidence-based intervention for the situation are those of de la Haye et al. (2019) and Pearce et al. (2019). The former is focused on obesity prevention in infants and studies the micro-level of interaction: as described above, it means person-to-person communication and individual approach. It researches the efficiency of home visitation programs in the United States, which work with low-income families to provide them with basic medical help and support (de la Haye et al., 2019). They are funded both by the government and private investors who are interested in promoting health literacy in the population. They help not only by providing services to the underserved part of the population but also by increasing their health literacy, which is crucial for obesity prevention. Unlike that, the latter study explores the meso-level of interaction: a general structure of the organization which helps obese people obtain treatment.
Conclusion
In general, the coalition should connect the scholarly information with their practical experience to use and distribute time and resources efficiently and treat obesity issues in the community. Its ethical code is it’s the most important part, as it defines its members’ responsibilities and values, along with the main action vector of the coalition. It should consist of community members who formulate issues to address, medical providers who treat those issues, stakeholders, who finance the coalition, and administrators who organize it. Together, they develop practices to address obesity factors and prevent it, such as health literacy increasing and health equity promotion.
References
Caballero, B. (2019). Humans against obesity: Who will win?Advances in Nutrition, 10(suppl_1), S4–S9.
Congdon, P. (2019). Obesity and urban environments. International Journal of Environmental Research and Public Health, 16(3), 464.
de la Haye, K., Fluke, M., Laney, P. C., Goran, M., Galama, T., Chou, C.-P., & Salvy, S.-J. (2019). In-home obesity prevention in low-income infants through maternal and social transmission. Contemporary Clinical Trials, 77, 61–69.
Elagizi, A., Kachur, S., Carbone, S., Lavie, C. J., & Blair, S. N. (2020). A review of obesity, physical activity, and cardiovascular disease.Current Obesity Reports, 9(4).
Ho, A., & Pinney, S. (2015). Redefining ethical leadership in a 21st-century healthcare system. Healthcare Management Forum, 29(1), 39–42.
Hurlimann, T., Peña-Rosas, J. P., Saxena, A., Zamora, G., & Godard, B. (2017). Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. PLOS ONE, 12(10), e0186897.
Lal, A., Peeters, A., Brown, V., Nguyen, P., Tran, H. N. Q., Nguyen, T., Tonmukayakul, U., Sacks, G., Calache, H., Martin, J., Moodie, M., & Ananthapavan, J. (2020). The modelled population obesity-related health benefits of reducing consumption of discretionary foods in Australia. Nutrients, 12(3), 649.
National Academies of Sciences, Engineering, and Medicine. (2019). A health equity approach to obesity efforts(E. A. Callahan, Ed.). National Academies Press.
Nimptsch, K., Konigorski, S., & Pischon, T. (2019). Diagnosis of obesity and use of obesity biomarkers in science and clinical medicine.Metabolism, 92, 61–70.
Pearce, C., Rychetnik, L., Wutzke, S., & Wilson, A. (2019). Obesity prevention and the role of hospital and community-based health services: a scoping review.BMC Health Services Research, 19(1).
Rubino, F., Puhl, R. M., Cummings, D. E., Eckel, R. H., Ryan, D. H., Mechanick, J. I., Nadglowski, J., Ramos Salas, X., Schauer, P. R., Twenefour, D., Apovian, C. M., Aronne, L. J., Batterham, R. L., Berthoud, H.-R., Boza, C., Busetto, L., Dicker, D., De Groot, M., Eisenberg, D., & Flint, S. W. (2020). Joint international consensus statement for ending stigma of obesity.Nature Medicine, 26(4), 485–497.
Stanford, F. C. (2020). The importance of diversity and inclusion in the healthcare workforce.Journal of the National Medical Association, 112(3).
Thornton, P. L., Kumanyika, S. K., Gregg, E. W., Araneta, M. R., Baskin, M. L., Chin, M. H., Crespo, C. J., Groot, M., Garcia, D. O., Haire‐Joshu, D., Heisler, M., Hill‐Briggs, F., Ladapo, J. A., Lindberg, N. M., Manson, S. M., Marrero, D. G., Peek, M. E., Shields, A. E., Tate, D. F., & Mangione, C. M. (2019). New research directions on disparities in obesity and type 2 diabetes. Annals of the New York Academy of Sciences, 1461(1), 5–24.
Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity “epidemic” and harms health.BMC Medicine, 16(1).
Wilkinson, T. M. (2018). Obesity, equity and choice. Journal of Medical Ethics, 45(5), 323–328.