文章基本信息

标题：Ethics and Obesity Prevention: Ethical Considerations in 3 Approaches to Reducing Consumption of Sugar-Sweetened Beverages
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作者：Nancy Kass ; Kenneth Hecht ; Amy Paul 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：5
页码：787-795
DOI：10.2105/AJPH.2013.301708
语种：English
出版社：American Public Health Association
摘要：Obesity and overweight prevalence soared to unprecedented levels in the United States, with 1 in 3 adults and 1 in 6 children currently categorized as obese. Although many approaches have been taken to encourage individual behavior change, policies increasingly attempt to modify environments to have a more positive influence on individuals’ food and drink choices. Several policy proposals target sugar-sweetened beverages (SSBs), consumption of which has become the largest contributor to Americans' caloric intake. Yet proposals have been criticized for unduly inhibiting choice, being overly paternalistic, and stigmatizing low-income populations. We explored the ethical acceptability of 3 approaches to reduce SSB consumption: restricting sale of SSBs in public schools, levying significant taxes on SSBs, and prohibiting the use of Supplemental Nutrition and Assistance Program (formerly food stamps) benefits for SSB purchases. Over the past 20 years, obesity and overweight have increased steadily among Americans. Labeled a national epidemic, 1 obesity affects 1 in 3 adults and 1 in 6 children. 2,3 Obesity is associated with stroke, diabetes, and heart disease, 4 with estimates of approximately $150 billion to $200 billion in health care costs annually. 5,6 Nearly half of non-Hispanic Blacks, 40% of Mexican Americans, and 34% of non-Hispanic Whites are obese 7 ; from the early 1990s to mid-2000s, the prevalence of obesity increased in adults at all income and education levels. 8 Simultaneously, more Americans are relying on federally funded nutrition assistance programs, with 14.5% of US households labeled food insecure (defined by the US Department of Agriculture as a household-level economic and social condition of limited or uncertain access to adequate food). 9,10 National conversations about obesity are occurring as data show a link, for so many Americans, between obesity and food insecurity. 11,12 Interventions for obesity must balance improvements in nutrition with improvements in food access, affordability, and availability. Numerous initiatives have aimed to encourage individuals to control their weight and make healthier choices. Food package labeling, required in 1990; the US Department of Agriculture’s 1992 food guide pyramid—replaced in 2011 with “MyPlate”; and Michelle Obama’s “Let’s Move!” campaign achieved significant visibility. In the private sector, $60 billion is spent annually in the diet industry, a breathtaking investment in individual behavior change. 13 Yet, whereas obesity prevalence was less than 15% in all states in 1990, by 2010 every state had prevalence of at least 20%. 4 Even with recent data indicating some possible stabilization of these trends, the rapid change in obesity rates over the past several decades 14 suggests that obesity, like tobacco and motor vehicle safety, may require interventions beyond those targeting individual behavior change. Several efforts have sought structural or “environmental” changes, including required calorie menu-labeling, limiting proximity of fast-food restaurants to schools, banning trans-fats in restaurants, and limiting high-caloric, low-nutrient food marketing to children. 15 These policies share a view that environments should be organized to make the healthy choice the easier choice. Whereas academic literature increasingly examines political and public health considerations in obesity prevention policies, less scholarship has addressed the ethical implications of different options. 16–18 Debates over obesity prevention proposals are, however, fueled by ethics considerations, with criticisms including assertions that such proposals unduly inhibit choice, are overly paternalistic, or stigmatize low-income populations. 6,19,20 In this article, we review what ethics demands of public health prevention policies. We then explore the ethical acceptability of 3 obesity prevention strategies aimed at reducing consumption of sugar-sweetened beverages (SSBs): (1) restricting sale of SSBs in public schools, (2) levying significant taxes on SSBs, and (3) prohibiting the use of Supplemental Nutrition Assistance Program (SNAP; formerly food stamps program) benefits for the purchase of SSBs.