Obesity in all age, gender, and ethnic groups has become one of the most pressing problems of our age. There are numerous types of health scenarios, which require different interventions to address the issue efficiently. Physicians and scholar may promote non-similar views on the condition and its treatment. It can be attributed to genetics, sedentary lifestyle, environmental factors, etc. Although plenty of programs have been launched at all government levels (addressing both childhood and adult obesity), the results of population cohort studies are quite deplorable.
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Obesity rates slow down only insignificantly for rather a short period of time after interventions are introduced (Masters et al., 2013). This implies that a totally new approach to research is required. Thus, the present study will assess the problem through different perspectives (instead of implementing a single-angle approach) to assess the arguments provided by supporters of each framework.
Obesity in both adults and children is one of the most acute and largely neglected health concerns of the modern world. This public health problem coexists with famine and malnutrition in all parts of the world despite the commonly accepted opinion that its prevalence can be attributed only to developed countries (Masters et al., 2013). The condition is common not only for every ethnicity or race but also for every gender and age group, which implies that the heritage of the whole planet is at stake if the problem remains unresolved.
However, if we study the historical background of obesity, it becomes evident that the condition simply did not exist during the early ages of our development. Paradoxically, numerous improvements in the human lifestyle (the transition from gathering and hunting to agriculture, the development of rural and urban infrastructure, food preparation, etc.) brought about a drastic drop in physical activities (Ogden, Carroll, Kit, & Flegal, 2014). With the passage of centuries and a number of industrial revolutions, this tendency was gradually aggravating, which led to the obese global community we can observe nowadays.
Basically, obesity appears when body weight regulation (the balance between energy expenditure and consumption) is disturbed, resulting in excessive accumulation of fat. The situation is typically aggravated by the lack of physical activity. As soon as the normal weight is exceeded by 20% (with variations for different age and gender groups as well as differences in weight and height correlations), the problem ceases to be an exclusively aesthetic concern turning into a complex and life-threatening disorder.
Most scholars agree that there are plenty of cases, in which the condition is directly responsible for the appearance of not only physical but also mental diseases. That is the reason it is now ranked the 5th among the most dangerous risk factors leading to the decreased life expectancy across the globe. The mortality rate from all causes (which are quite numerous) is 20% higher in the obese population as compared to people with normal weight (Masters et al., 2013).
The most widespread conditions caused by obesity include elevated blood pressure, stroke, type 2 diabetes mellitus, kidney failure, sleep apnoea, cardiovascular diseases, mental problems, osteoarthritis, etc. It also increases the risks of kidney, liver, colon, breast, endometrial, gallbladder, and other types of cancer. All these health hazards significantly damage the patient’s state and diminish the quality of life (even if only one of them is actually materialized) (Ogden et al., 2014). Another problem is that some of these detrimental consequences can emerge even in the early childhood, preventing children from normal development into healthy adults and putting them at risk of having a disability throughout the whole life.
Despite the fact that it is believed by many non-professionals that obesity is linked to prosperity and oversaturation of the society, the fact is that children coming from poor and middle-income countries are more likely to suffer from a whole range of inadequate nutritional states. This can be accounted by the fact that such children are always exposed to unhealthy foods (since they are less costly) that are high in sugar, salt, fat, and additives while being poor in micronutrients and vitamins. Even in developed states, obesity is prevalent in low-education and low-income social classes as well as in different minorities groups.
Besides threatening health, obesity is also connected with financial problems as productivity of obese individuals is considerably reduced while their medical expenses are at least 30% higher. According to the recent estimations, the direct costs of obesity have reached 10% of the overall healthcare spending in the US (Masters et al., 2013).
The ecological approach to public health problems (also often referred to as socio-ecological) stresses the importance of physical and social environments as well as human responses to them since, being combined, these factors create disease and health patterns of individuals (Engel et al., 2016). Basically, viewing the problem through the ecological lens implies looking for linkages that connect all the factors producing a positive or a negative impact on health.
A representative range of conditions describing obesity predisposition from the given perspective might include:
- Individual characteristics. In case of obesity, not only generic but also epigenetic factors (which refer to certain changes in gene expression that do not affect the DNA) must be taken into account. It has been proven that being exposed to maternal obesity or endocrine disrupting chemicals, a child may develop disorders that he/she will carry throughout the whole life.
- The interpersonal level. In this category, there are such cultural factors as cuisine, product preferences, and attitude to physical fitness. The caregiver behavior also plays an important role. For instance, parents may be too pressed for time to cook, which diminishes the important role of healthy food habits.
- Institutional factors. Food behaviors may change with adulthood since workplace options as well as time for performing physical activities may be limited. Thus, the obesity risk may be minimized if a firm provides a healthy menu and an opportunity to visit workouts in a gym.
- Community factors. This level is broader than the previous one; yet, it involves the same constituents: access to sports facilities, affordability of healthy food, having community norms related to food choices and attractive figures, etc. For instance, in Burma, thin girls are sent to special “fat camps”, where their caregivers make them eat a lot of fat food to gain weight since overweight or even obese women are considered to be beautiful and wealthy.
- Social, political, and economic levels. School food programs, chemicals in products, the state of agriculture, and other high-level factors can be referred to this group (Engel et al., 2015).
Human Rights Lens
The human rights lens presupposes viewing any problems primarily from the perspective of its influence on fundamental human rights to see if any of them are violated (Dittmer, 2017). The aspects analyzed typically include worth, dignity, value of each person, respect to all citizens, and government duties towards them.
First and foremost, the fact that policies related to obesity prevention are formulated and accepted by people who will not be influenced by their implementation can be regarded as violation of human rights (Dittmer, 2017). Basically, the policy is imposed upon the obese population without asking people’s opinion, which contradicts the principles of a democratic society, where no one can be forced to participate in any activities that directly affect the person’s health.
At the same time, the country’s identity politics neglects the problem of discrimination on the basis of obesity. Excess weight is still regarded as a disqualifying factor for a number of occupations (e.g. obese physician’s qualification is questioned). While obesity prevention programs are gaining popularity, the protection of obese people’s rights from biasing is largely discarded (Dittmer, 2017). As a result, the reaction of the society is rather predictable. Human rights of people suffering from the condition are nullified since such a neglectful attitude of the government makes people believe in individual responsibility of the affected (totally ignoring the influence of genetic, social or other factors).
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It has already been mention that the cost of healthcare is much higher for obese people. However, this is far from being the only economic penalty of their disorder. They also have unequal labor, recreational, sports, and other opportunities with healthy people (Dittmer, 2017). Moreover, they have to pay more even for public accommodation and clothes.
Health Belief Model
The health belief model provides another possible way of viewing and explaining individual behaviors in relation to health, focusing on people’s attitudes to various health-related conditions (Dittmer, 2017). In other words, it is believed that a person will take measures if he/she feels that a negative condition must be treated and has an expectation of a positive outcome after performing a recommended action. This attitude depends on perceived severity, susceptibility, benefits, barriers, cues to action, and self-efficacy of each person.
Thus, application of this framework to obesity means making the major emphasis on the above-enumerated individual factors. Perceived susceptibility then implies that each individual has certain opinion concerning his/her chances of being overweight, which partially determines food behavior. If people realize that they do have this predisposition, they must assess how severe it is likely to be. As for perceived benefits, unfortunately, a lot of obese patients do not believe in the efficacy of the solution to their problem, which implies that their readiness (cues to action) is not activated. Neither do they believe in their own efficacy or the ability to struggle. At the same time, they clearly see all the associated tangible and intangible costs (perceived barriers) (Dittmer, 2017).
While adults experience the majority of concerns due to their psychological unpreparedness to deal with the problem, obese children have to suffer also from their own parents’ lack of intervention. Although they cannot exercise their health beliefs directly, their rights are addressed by the Right to Health, the Right to Adequate Food, and UN Convention on the Rights of the Child. They must be protected from all harmful influences or circumstances, which can negatively affect their wellbeing (Dittmer, 2017). Food insecurity arises from marketing unhealthy products that commercially exploit children’s preferences if their parents do not keep track of their nutrition.
The capabilities approach makes the main emphasis on the capability of a person to have the kind of life that he/she finds valuable and deserved. Unlike the previous model, this framework does not imply subjective welfare, depending entirely the person’s attitude to the perceived outcomes. Neither should it be equaled to the availability of all the necessary means to avoid or achieve the desired state-of-art (Venkatapuram, 2013). It should rather be assessed in terms of what a person can do both objectively and subjectively.
Analyzing obesity from this perspective leads to the following conclusions:
- Obese people can have considerable differences in their capability to utilize the same means and resources and benefit from their use. For instance, the same workout machines may be effective for one obese patient and totally ineffective for another. Therefore, providing means to treat obesity is not enough. It must be ensured that they are effective for this or that individual.
- Problem denial may be adopted by people due to the development of the so-called “adaptive preferences”. In other words, the patient will believe and declare that his/her weight is fine and does not have any impact of the overall wellbeing, especially if he/she does not believe in the effectiveness of treatment. That implies that purely self-reported information is insufficient.
- It is important for people to have options to be able to take them. If there is no opportunity to purchase healthy products in the community, there is no effective freedom or capability either.
- If people use their capabilities, the weight loss is not the only assessment indicator. A person may do well but feel frustrated, which requires intervention (Venkatapuram, 2013).
The transtheoretical model is a framework of behavior change that allows estimating how well a person is ready to accept new, healthier patterns of conduct. Moreover, it provides strategies for an individual to make the change successful (Romain, Bernard, Hokayem, Gernigon, & Avignon, 2016). The constructs of the model include stages, processes, and levels of change as well as decisional balance and self-efficacy.
Thus, according to this approach, the success of obesity management depends on the readiness stage:
- Pre-contemplation. The person is unprepared to deal with the problem either immediately or in the nearest future since he/she does not perceive his/her problems with weight as problematic.
- Contemplation. The individual starts to realize that measures should be taken to reduce the body mass as soon as possible since otherwise health consequences will follow.
- Preparation. The person is completely ready to take action immediately. He/she may even try to take some small steps independently to launch the process of change and accelerate the appearance of the first results.
- Action. Obese patients modify their unhealthy dietary habits and start being more physically active to acquire a new body and self-perception.
- Maintenance. The individual shows his/her capability to maintain the results of the weight loss for at least half a year and does his/her best to prevent future relapses.
- Termination. The patient no longer has any temptation to eat excessively and is unlikely to gain weight again (Romain et al., 2016).
Although being rather demonstrative in terms of describing a weight loss process, the model is widely critiqued for the attempt of giving a quantitative definition to each stage since it is quite impossible to identify how long they can last in each individual case.
Individual Factors Model
The individual factors model relies on the assumption that the major role of health outcomes is attributed to the individual behavior. In other words, each person is the only one to blame for having weight problems since they come as a result of wrong choices (Jokela et al., 2013). This is the most common way of perceiving obesity among those who are not affected by it.
The idea is that each individual decides how to divide time between sleep, paid work (studies), non-paid work (household and other issues), leisure activities, and transportation. Due to the rapidly developing and highly demanding business environment (alongside with home activities that cannot be canceled), a lot of people give preference to sedentary leisure. In order to save time, they also opt for personal transport instead of walking or biking to work. Moreover, it is now a widespread problem of not having time or desire to cook, which leads to the development of unhealthy nutrition habits. As a result, the combination of the absence of physical activities and fast food gives obesity in the long run. The situation may be aggravated by other detrimental habits such as smoking and alcohol consumption.
The proponents of the individual factors framework believe that all these personal choices predetermine the outcome of obesity prevention and management. They purposefully disregard the role of other factors, such as environmental, social, financial, cultural, genetic, etc. that may also contribute to the development of the disorder. Furthermore, it is questionable whether this model can be applied to children, whose choices are predetermined by their parents’ attitudes (Jokela et al., 2013). Neither does it seem to be applicable to low-income communities, whose opportunities are limited.
Having analyzed the key approached to the problem of obesity, it seems that each one has certain benefits and drawbacks. That is why it is recommended to combine some of their best features, making the ultimate framework more comprehensive. The ecological lens is now often implemented by healthcare specialists to analyze obesity as it seems to a lot of scholars that it takes into account the major factors predetermining the condition. Thus, the model is convenient to use as it arranges all the obesity aspects from the micro to the macro level and groups them into the following categories:
- individual (generics and personal behaviours);
- interpersonal (family environment and characteristics, social interactions, etc.);
- institutional and community (workplace, service systems, educational institutions, transportation, etc.)
- social, political, and economic (any laws or social regulations).
However, its effectiveness in actual management of the condition is arguable since the framework allows understanding only the big picture without narrowing the focus. The model does not specify what can or cannot be done to deal with every level of factors in each individual case. That is why it would be more effective if it is combined with the capabilities approach, which takes into account personal subjective and environmental objective factors, which will make it possible to implement it for developing treatment options.
Although the human rights approach is rather one-sided, it would still be wrong to ignore its points. Applying the human rights framework to the issue of obesity gives an entirely new vision of the problem, which lies beyond the public health. Health legislature becomes increasingly important for the industry, in which ethics is one of the primary concerns.
Dittmer, J. (2017). The good doctors: The medical committee for human rights and the struggle for social justice in health care. Jackson, MS: University Press of Mississippi.
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Romain, A. J., Bernard, P., Hokayem, M., Gernigon, C., & Avignon, A. (2016). Measuring the processes of change from the transtheoretical model for physical activity and exercise in overweight and obese adults. American Journal of Health Promotion, 30(4), 272-278.
Venkatapuram, S. (2013). Health justice: An argument from the capabilities approach. Hoboken, NJ: John Wiley & Sons.