The Ethics of Obesity: Investigating Ethical Conflicts Between the Biomedical, Social, and Public Health Views in the United States Público
Burklin, Yelena (Summer 2022)
Abstract
Defined by the American Board of Obesity Medicine, obesity is a chronic, progressive, relapsing, and treatable multifactorial neuro-behavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic biomechanical and psychosocial health consequences. Proper recognition of this medical disease is lacking. Unfortunately, harmful misrepresentations in society — especially demeaning portrayals in the film industry — lead to widespread misunderstandings of the causes, preventative measures, and treatment of obesity. Marginalizing people based on their body weight is morally wrong and epistemically unsound. Not only does it reduce the moral worth of people with obesity by excluding them from moral consideration, but it stands in contradiction with contemporary biomedical science and the knowledge about the disease’s multifactorial etiology. In response to the discrimination and negative stigmatization of obesity, a “fat activism” movement has arisen and rejects the medicalization of obesity, viewing it as oppression. The “fat activists” claim that obesity should not be medicalized and urge to reframe the fat tissue. Using a logic derived from the identity-based affirmation, they argue that people without obesity—including qualified scientific researchers—do not have any epistemic authority around questions of obesity. The “fat activists” deprive other people with obesity of making informed, autonomous choices about their health: this is unethical and epistemically unsound. One should not reject research conducted by people without obesity simply because of their body size. It is also unjust to undermine the epistemic authority of people with obesity by stereotyping them as lazy and lacking the self-control necessary for scientific objectivity. The thesis investigates the ethical conflicts between the biomedical, social, and public health views of obesity using the four main ethical principles of beneficence, non-maleficence, autonomy, and justice. It also argues from the standpoint of moral theories of virtue and care as it applies to the construct of moral inclusion and exclusion. An ethical framework to address the problem of obesity stigmatization without rejecting the available medical knowledge is suggested. Such an approach would help people with obesity make informed, autonomous decisions about their health and attain human flourishing.
Table of Contents
Table of Contents:
Introduction: (page 1)
Chapter 1: Obesity in the United States – a biomedical view and the concept of metabolically healthy obesity (Page 4)
i. What is obesity? (Page 4)
ii. Obesity statistics in the United States (Page 4)
iii. Pathophysiology of obesity (Page 6)
iv. Metabolic (or metabolically) healthy obesity (Page 7)
v. Bioethical relevance of the discussion pertaining to obesity misrepresentation and misconception (page 9)
Chapter 2: Current culture of obesity stigmatization as portrayed in the film industry (Page 11)
i. The role of the physiologic obesity paradox in misrepresentation and misinterpretation of metabolic disease (Page 11)
ii. Obesity misrepresentation in the film industry contributes to the development of bias, stigmatization, and discrimination (Page 12)
iii. A response to the dominant culture’s inaccurate view on obesity gives rise to “fat activism” and pseudo-body positivity mentality (Page 15)
a. Development of pro-obesity movement as an attempt to normalize obesity (Page 15)
b. Promotion of pseudo-body positivity in the film industry as an attempt to destigmatize obesity (Page 16)
Chapter 3: Applying a principle-based approach in the investigation of the ethical conflict surrounding obesity stigma and misperception in pro-obesity and anti-obesity movements (Page 19)
i. Viewing the autonomy of people living with obesity from the position of celebrities who serve the stigma-promoting movie industry: how obesity bias and myths affect them. (Page 19)
ii. “Fat positivity” and “fat activism” as it relates to the principle of justice in the ethics of obesity misperception and stigmatization. (Page 21)
iii. The role of a non-maleficence principle in the discussion of the ethics of obesity (Page 24)
iv. The principle of beneficence and duty to care: moral imperative and rationale for paternalism (Page 25)
Chapter 4: The role of moral theories in addressing ethical conflict that surrounds obesity within the modern community (Page 32)
i. The value of the theory of moral exclusion and inclusion as it pertains to obesity bias and marginalization (Page 32)
ii. The utility of the ethics of care and virtue in the ethics of obesity. (Page 36)
iii. A value of moral worth in the ongoing conflict between the positions of “fat activists” and anti-obesity proponents (Page 39)
a. Moral character and moral worth (Page 40)
b. Moral worth and reciprocity (Page 42)
Chapter 5: Response to the dominant cultural view of obesity claim (Page 45)
i. The role of “fat activism” in portraying obesity and the risks of anti-obesity (Page 45)
ii. The justifications of the “fat activist” groups (Page 47)
a. De-escalate discrimination (Page 47)
b. Promote additional epistemology (Page 47)
c. Bring a sense of belonging (Page 47)
d. Attempts to achieve ethically acceptable goals in addressing obesity (Page 48)
Chapter 6: Human flourishing and obesity (Page 49)
Chapter 7: Public health ethics of obesity; the ethical issues in the public sector and legislation (Page 52)
i. The role of public health ethics in representing obesity and ways to achieve obesity de-stigmatization (Page 52)
ii. Obesity misinterpretation as a moral flaw – political views that enable obesity ignorance and ways to overcome the misperceptions (Page 53)
iii. Legislation challenges in destigmatizing obesity (Page 54)
iv. Ethical conflicts of approaching obesity in public sectors (Page 56)
v. Whose justice is it, anyway? The narratives of justice in obesity portrayal and management. (Page 58)
Chapter 8: Ethical framework in the ethics of obesity (Page 63)
i. The need for a public health ethics framework (Page 63)
ii. Reframing obesity to achieve moral acceptance in the conflict between anti-obesity and pro-obesity proponents (Page 65)
Conclusion: (Page 66)
Appendix: Figure 1 (Page 72)
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